Empire Dermatology Pllc

CLIA Laboratory Citation Details

2
Total Citations
12
Total Deficiencyies
7
Unique D-Tags
CMS Certification Number 33D2117332
Address 5823 Widewaters Parkway, Suite 10, E Syracuse, NY, 13057
City E Syracuse
State NY
Zip Code13057
Phone(315) 500-7546

Citation History (2 surveys)

Survey - February 13, 2025

Survey Type: Standard

Survey Event ID: O5OA11

Deficiency Tags: D5415 D5291 D6107 D5209 D6103 D5415 D6103 D6107

Summary:

Summary Statement of Deficiencies D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES CFR(s): 493.1235 As specified in the personnel requirements in subpart M, the laboratory must establish and follow written policies and procedures to assess employee and, if applicable, consultant competency. This STANDARD is not met as evidenced by: Based on review of Standard Operating Procedures (SOPs), competency assessment records, as well as interviews with the Testing Person (TP) and the Office Manager (OM), the laboratory failed to perform and document competency assessments. FINDINGS: 1. There was no documentation of competency assessment performance for the Laboratory Director (LD), Clinical Consultant (CC), Technical Supervisor (TS), General Supervisor (GS), and Testing Personnel responsible for performing PPMP. 2. This was contrary to instructions included in the current, approved SOPs. 3. The TP and OM confirmed the findings on February 13, 2025, at 3:30 P.M. D5291 GENERAL LABORATORY SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1239(a) The laboratory must establish and follow written policies and procedures for an ongoing mechanism to monitor, assess, and, when indicated, correct problems identified in the general laboratory systems requirements specified at 493.1231 through 493.1236. This STANDARD is not met as evidenced by: Based on review of laboratory systems Quality Assurance (QA) procedures, QA records, as well as interviews with the TP and the OM, the laboratory failed to 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 -- perform and document QA. FINDINGS: 1. There was no documentation of QA records for years 2023 and 2024. 2. This was contrary to instructions indicated in the current, approved QA Plan. 3. The TP and OM confirmed the findings on February 13, 2025, at approximately 3:10 P.M. D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(c) (c) Reagents, solutions, culture media, control materials, calibration materials, and other supplies, as appropriate, must be labeled to indicate the following: (c)(1) Identity and when significant, titer, strength or concentration. (c)(2) Storage requirements. (c)(3) Preparation and expiration dates. (c)(4) Other pertinent information required for proper use. This STANDARD is not met as evidenced by: Based on direct observation, review of SOPs, as well as interview with the TP, the laboratory failed to properly identify the reagent, concentration, lot number, expiration date, and storage requirements for the solution/reagent positions located on the automated stainer in the Mohs processing lab. FINDINGS: a. The surveyor's observations in the Mohs processing laboratory on February 13, 2025, at approximately 11:30 A.M. confirmed the following reagents located on the Thermo Scientific Linistain automated stainer, SN: LS5024A1609, in the Mohs laboratory, were not labeled with identification, concentration, lot number, expiration date, and storage requirements: 1. 95% Alcohol 2. Water 3. Hematoxylin 4. 0.1% Acid Alcohol Solution 5. Eosin Y 6. 100% Alcohol 7. Xylene substitute b. The current, approved SOPs did not include instructions for performing such activity. c. The TP confirmed the findings on February 13, 2025, at approximately 3:00 P.M. D6103 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(13) (e)(13) Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to assure that they are competent and maintain their competency to process specimens, perform test procedures and report test results promptly and proficiently, and whenever necessary, identify needs for remedial training or continuing education to improve skills; This STANDARD is not met as evidenced by: Based on review of SOPs, competency assessment records, as well as interviews with TP and the OM, the LD failed to perform and document personnel competency assessment performance as well as comply with instructions included in the current, approved SOPs. Refer to D5209. D6107 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(15) (e)(15) Specify, in writing, the responsibilities and duties of each consultant and each supervisor, as well as each person engaged in the performance of the preanalytic, analytic, and postanalytic phases of testing, that identifies which examinations and procedures each individual is authorized to perform, whether supervision is required -- 2 of 3 -- for specimen processing, test performance or result reporting and whether supervisory or director review is required prior to reporting patient test results. This STANDARD is not met as evidenced by: Based on review of SOPs, laboratory policies, as well as interviews with the TP and the OM, the laboratory failed to draft, approve written responsibilities and duties for each person involved in all phases of testing. FINDINGS: 1. The current, approved SOPs and laboratory policies did not include documentation of LD, CC, TS, GS, and TP job descriptions. 2. The TP and OM confirmed the findings on February 13, 2025, at 3:30 P.M. -- 3 of 3 --

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Survey - September 26, 2018

Survey Type: Standard

Survey Event ID: 2VP611

Deficiency Tags: D5217 D5217 D5433 D5433

Summary:

Summary Statement of Deficiencies D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. This STANDARD is not met as evidenced by: Based surveyor's review of the twice year verification procedure, twice year verification for the Mohs slides, and an interview with the Mohs technician, the laboratory failed to verify the accuracy of interpretation of the KOH at least twice per year for calendar year 2017. FINDINGS: The Mohs technician confirmed on September 26, 2018 at approximately 9:30 AM, the surveyor's findings that the laboratory failed to verify the accuracy of the KOH slides for the calendar year 2017. Approximately 92 patients' KOH slides were interpreted and reported in calendar year 2017. D5433 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(1) 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 establish a maintenance protocol that ensures equipment, instrument, and test system performance that is necessary for accurate and reliable test results and test result reporting. The laboratory must perform and document the maintenance activities specified in paragraph (b)(1)(i) of this section. This STANDARD is not met as evidenced by: 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 -- Based on surveyor's review of the Mohs procedure manual, cryostat service and preventative maintenance records and an interview with the Mohs technician, the laboratory failed to document the daily and as needed maintenance, as indicated by the cryostat maintenance procedure. -- 2 of 2 --

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