Dycus-Camp Clinic

CLIA Laboratory Citation Details

2
Total Citations
11
Total Deficiencyies
4
Unique D-Tags
CMS Certification Number 37D0471800
Address 320 N Service Rd, Moore, OK, 73160
City Moore
State OK
Zip Code73160
Phone(405) 794-4474

Citation History (2 surveys)

Survey - January 7, 2020

Survey Type: Standard

Survey Event ID: PT7E11

Deficiency Tags: D0000 D5413 D5429 D5435 D5413 D5429 D5435

Summary:

Summary Statement of Deficiencies D0000 The recertification survey was performed on 01/07/20 The findings were reviewed with the testing person at the conclusion of the survey. The laboratory was found in compliance with standard-level deficiencies cited. D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on a review of records, manufacturer's instructions, and interview with the testing person, the laboratory failed to ensure blood collection tubes were stored as required by the manufacturer for 1 of 5 months. Findings include: (1) At the beginning of the survey, the testing person stated the following to the surveyor: (a) Routine CBC (Complete Blood Count) testing was performed using the Abbott Cell- Dyn 1800 analyzer; (b) Blood collection tubes were used for the following: (i) Patient testing on the Abbott Cell-Dyn 1800 analyzer (2) Later during the survey, the surveyor reviewed the manufacturer's environmental requirements for: (a) Blood collection tubes - required a room temperature 4-25 degrees C (Celsius) (i) BD Vaccutainer K2 EDTA (100 tubes of lot# 9260500) (3) The surveyor reviewed temperature records for 5 months (August 2019 through December 2019). It was identified that documented temperatures were warmer than 25 degrees C for 1 of 5 months as follows: (a) August 2019 - 3 of 31 temperatures were documented as warmer than 25 degrees C (Days 13,19,20); (4) The surveyor reviewed the records Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 3 -- with the testing person who stated the materials had not been stored according to manufacturer's instruction. D5429 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(a)(1) For unmodified manufacturer's equipment, instruments, or test systems, the laboratory must perform and document maintenance as defined by the manufacturer and with at least the frequency specified by the manufacturer. This STANDARD is not met as evidenced by: Based on a review of records, manufacturer's instructions, and interview with the testing person, the laboratory failed to follow the manufacturer's instructions for performing maintenance procedures for 1 of 5 months. Findings include: (1) At the beginning of the survey, the testing person stated to the surveyor that CBC (Complete Blood Count) testing was performed on the Abbott Cell-Dyn 1800 analyzer; (2) Later during the survey, the surveyor reviewed the manufacturer's maintenance requirements as stated on the manufacturer's maintenance logs. The requirements for weekly maintenance were as follows: (a) Auto Clean (b) Clean Aspiration Probe Exterior (3) The surveyor then reviewed maintenance records for 5 months (August 2019 through December 2019). There was no evidence the weekly maintenance had been performed: (a) Between 01/02/19 and 11/06/19 (4) The surveyor reviewed the records with the testing person, who stated the maintenance had been performed but not documented as required. D5435 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(2) For equipment, instruments, or test systems developed in-house, commercially available and modified by the laboratory, or maintenance and function check protocols are not provided by the manufacturer, the laboratory must: (i) Define a function check protocol that ensures equipment, instrument, and test system performance that is necessary for accurate and reliable test results and test result reporting. (ii) Perform and document the function checks, including background or baseline checks, specified in paragraph (b)(2)(i) of this section. Function checks must be within the laboratory's established limits before patient testing is conducted. This STANDARD is not met as evidenced by: Based on a review of records, policy, and interview with the testing person, the laboratory failed to ensure the urine centrifuge was functioning properly for 1 of 2 years Findings include: (1) At the beginning of the survey, the testing person stated to the surveyor urine sedimentation testing was performed in the laboratory. The specimens were processed in the Druker Centrifuge Model 614V centrifuge at a speed of 1750 rpm (revolutions per minute) for 5 minutes; (2) The surveyor reviewed the centrifuge function check policy which required annual speed checks be performed on the centrifuge; (3) The surveyor reviewed the centrifuge maintenance records for 2018 and 2019. The speed had not been checked at the speed the urine specimens were processed, to ensure the centrifuge was functioning properly at that speed, for 1 of 2 checks performed as follows: (i) 07/01/19 - The speed had been checked at 1500 rpm and 2000 rpm. (4) The surveyor reviewed the findings with the testing person. The testing person stated the centrifuge speed had not been checked at the speed used to -- 2 of 3 -- process urine specimens as indicated above. D5435 was cited on the recertification survey performed on 01/25/18. -- 3 of 3 --

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Survey - January 25, 2018

Survey Type: Standard

Survey Event ID: 8TLM11

Deficiency Tags: D0000 D5435 D0000 D5435

Summary:

Summary Statement of Deficiencies D0000 The findings were reviewed with testing person #1 at the conclusion of the survey. D5435 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(2) For equipment, instruments, or test systems developed in-house, commercially available and modified by the laboratory, or maintenance and function check protocols are not provided by the manufacturer, the laboratory must: (i) Define a function check protocol that ensures equipment, instrument, and test system performance that is necessary for accurate and reliable test results and test result reporting. (ii) Perform and document the function checks, including background or baseline checks, specified in paragraph (b)(2)(i) of this section. Function checks must be within the laboratory's established limits before patient testing is conducted. This STANDARD is not met as evidenced by: Based on a review of records, policies and procedures, and interview with testing person #1, the laboratory failed to have a written function check protocol to ensure the centrifuge functioned properly. Findings include: (1) At the beginning of the survey, testing person #1 stated to the surveyor the laboratory performed microscopic urinalysis and patient urine specimens were centrifuged at a speed of 1750 RPM (Revolutions Per Minute) at a time of 5 minutes in the Model 614V centrifuge; (2) The surveyor reviewed the annual function check (speed and timer check) records from 2017 and 2018 for the centrifuge and identified the following information: (a) 02 /05/17: (i) The speed was checked at 1500 RPM; (ii) The result of the check was 1550 RPM; (iii) There was no acceptable limits included on the form. (b) 01/22/18: (i) The speed was checked at 1500 RPM; (ii) The result of the check was 1540 RPM; (iii) There was no acceptable limits included on the form. (3) The surveyor observed the stickers on the centrifuge from the function checks listed above. A speed of 1500 RPM was checked instead of 1750 RPM, the speed used by the laboratory for centrifuging urine samples. In addition, the stickers not did include the acceptable Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- limits for the speed function check result; (4) The surveyor then reviewed the laboratory policy and procedure manual but could not locate a policy/procedure for performing centrifuge function checks. The surveyor asked testing person #1 how the acceptability of the function checks was determined. Testing person #1 explained the technician who performed the checks would document on the record if the results were unacceptable; (5) The surveyor asked testing person #1 if the laboratory had a written function check protocol for the urine centrifuge, which included the speed to be checked and included acceptable limits for the speed and timer function checks. Testing person #1 explained a function check protocol had been written but could not be located. -- 2 of 2 --

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