Essentia Health Hibbing Clinic

CLIA Laboratory Citation Details

1
Total Citation
1
Total Deficiency
1
Unique D-Tag
CMS Certification Number 24D0403746
Address 730 East 34th St, Hibbing, MN, 55746
City Hibbing
State MN
Zip Code55746
Phone(218) 263-1000

Citation History (1 survey)

Survey - December 18, 2018

Survey Type: Standard

Survey Event ID: FESG11

Deficiency Tags: D5415

Summary:

Summary Statement of Deficiencies D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(c) Reagents, solutions, culture media, control materials, calibration materials, and other supplies, as appropriate, must be labeled to indicate the following: (1) Identity and when significant, titer, strength or concentration. (2) Storage requirements. (3) Preparation and expiration dates. (4) Other pertinent information required for proper use. This STANDARD is not met as evidenced by: . Based on observation, document review and interview with laboratory personnel, the laboratory failed to label secondary containers used for Hematology manual blood smears. Findings are as follows: 1. The laboratory performed Hematology testing as confirmed by the General Supervisor (GS) during a tour of the laboratory on 12/18/18 at 9:10 a.m. 2. Two unlabeled glass jars containing liquid were observed as available for use in the laboratory during the tour. 3. The GS stated the unlabeled jars contained the Wright stain set up used for manual blood smears. 4. In an interview on 12/18/18 at 9:20 a.m., the GS confirmed the jars were not labeled. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --

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