Evans Memorial Hospital

CLIA Laboratory Citation Details

4
Total Citations
14
Total Deficiencyies
10
Unique D-Tags
CMS Certification Number 11D0260979
Address 200 North River Street, Claxton, GA, 30417
City Claxton
State GA
Zip Code30417
Phone(912) 739-5000

Citation History (4 surveys)

Survey - October 29, 2024

Survey Type: Standard

Survey Event ID: 9SYS11

Deficiency Tags: D5413 D5423 D0000 D5417

Summary:

Summary Statement of Deficiencies D0000 A recertification survey was performed on , October 30, 2024. The facility was found to be NOT in compliance with all applicable CLIA requirements for specialties /subspecialties for 42 CFR. 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: Observation during the tour of the laboratory and staff interview confirmed there was a bottle of Acetic Acid, a caustic solution, stored in an upper cabinet above the working area. Findings: 1. Observation during the tour of the laboratory confirmed that a bottle of Acetic Acid stored in the upper cabinet, above the working area. Caustic agents should be stored in a metal fire cabinet or metal biohazard cabinet. 2. An interview with the General Supervisor (GS), on 10/29/2024, at approximately 10: 15 am, in the laboratory confirmed the information above. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. 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 -- This STANDARD is not met as evidenced by: A tour of the laboratory, and staff interview, confirmed opened, expired reagents in the laboratory for the Beckman Coulter DxH(BCDxH) 690T hematology analyzer in the refrigerator as well as expired saline solution on the counter in Blood Bank (BB). FIndings: 1. Observation during the tour of the laboratory confirmed that the Coulter S Cal reagents, used for the calibration of the BCDxH hematology analyzer, expired on 10/12/2024. 2. Observation during the tour of the laboratory it was confirmed that the open container of Blood Bank (BB) saline, was marked as being open on 08/12 /2024. Blood Bank saline has a shelf life of one month (30 days) from the open date. 3. Interview with the Laboratory Supervisor (LS), on 10/29/2024, at approximately 10: 20 am, in the laboratory, confirmed the expired Coulter S Cal reagents in the laboratory. Interview with the LS on 10/29/2024 at approximately 10:25 am in the BB area, confirmed the expired BB saline container. D5423 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE CFR(s): 493.1253(b)(2) Each laboratory that modifies an FDA-cleared or approved test system, or introduces a test system not subject to FDA clearance or approval (including methods developed in-house and standardized methods such as text book procedures), or uses a test system in which performance specifications are not provided by the manufacturer must, before reporting patient test results, establish for each test system the performance specifications for the following performance characteristics, as applicable: (2)(i) Accuracy. (2)(ii) Precision. (2)(iii) Analytical sensitivity. (2)(iv) Analytical specificity to include interfering substances. (2)(v) Reportable range of test results for the test system. (2)(vi) Reference intervals (normal values). (2)(vii) Any other performance characteristic required for test performance. This STANDARD is not met as evidenced by: Observation during the laboratory tour, and staff interview, confirmed that the Fisher Scientific IsoTemp Cooler had not been serviced by BioMed since 08/25/2023, the date of installation. Findings: 1. Observation during the laboratory tour confirmed that the IsoTemp Cooler had not not been by serviced by BioMed since it was installed on 08/25/2023. The date of annual service should have been completed on or before 08/25 /2024. 2. Interview with the Laboratory Supervisor , on 10/29/2024, at approximately 10:45 am, in the laboratory, confirmed the statements above. -- 2 of 2 --

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Survey - October 19, 2022

Survey Type: Standard

Survey Event ID: B8U711

Deficiency Tags: D0000 D5417 D6076 D5400 D6072 D6093

Summary:

Summary Statement of Deficiencies D0000 Based on the onsite recertification survey conducted on 10/19/2022, this facility was found NOT in compliance with CLIA regulations found at 42 CFR 493.1250 Condition: Analytic Systems 493.1403 Condition: Laboratory Director D5400 ANALYTIC SYSTEMS CFR(s): 493.1250 Each laboratory that performs nonwaived testing must meet the applicable analytic systems requirements in 493.1251 through 493.1283, unless HHS approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub.7), that provides equivalent quality testing. The laboratory must monitor and evaluate the overall quality of the analytic systems and correct identified problems as specified in 493.1289 for each specialty and subspecialty of testing performed. This CONDITION is not met as evidenced by: Based on review of the Blood Bank (BB) Quality Control Records, BB Transfusion Record Log, and staff interview, it was revealed the laboratory failed to ensure quality lab services in analytic systems. The findings incude: 1. The laboratory failed to ensure that reagents used for BB testing had not exceeded their expiration date prior to patient testing. (refer to D5417). D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. 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 3 -- Based on review of the Blood Bank (BB) Quality Control Records (QCR), and staff interview, the laboratory failed to ensure testing reagents did not exceed their expiration date prior to clinical use. The findings include: 1. A review of the of the BBCC (Blood Bank Check Cells) QCR data, from November 2020 to October 2022, revealed: a. 02/23/2022 BBCC used this day of testing was documented as expired on 02/21/2022 There was a two unit crossmatch performed on this day b. 03/30/2022, BBCC used this day of testing was documented as expired on 03/28/2022 There was a two unit crossmatch and Group and rH performed on this day c. 05/24/2022 BBCC used this day of testing was documented as expired on 5/23/2022. There was a one unit crossmatch performed on this day d. 06/23/2022 BBCC used this day of testing was documented as expired on 06/20/2022. There was a two unit crossmatch performed on this day. 2. An interview with the Laboratory Technical Supervisor, and the BB General Supervisor, on 10/19/2022, at approximately 2pm, in the Hospital Conference Room, confirmed the above findings. D6072 TESTING PERSONNEL RESPONSIBILITIES CFR(s): 493.1425(b)(3) Each individual performing moderate complexity testing must adhere to the laboratory's quality control policies, document all quality control activities, instrument and procedural calibrations and maintenance performed. This STANDARD is not met as evidenced by: Based on review of the Blood Bank Quality Control Record (BBCR) and staff interview, it was revealed the testing personnel failed to recognize that the Blood Bank Check Cells (BBCC), used on four days of patient testing, expired prior to the date of clinical use. The findings include: 1. A review of the BBCR revealed that laboratory personnel are required to write the lot number and expiration date of the reagents in use for the Blood Bank (BB) testing on the day of testing. 2. The laboratory personnel failed to recognize that the BBCC, in use the day of testing, had expired. a. patient testing performed 02/23/2022, BBCC cells documented as expired on 02/21/2022 b. patient testing performed 03/30/2022, BBCC cells documented as expired on 03/28/2022 c. patient testing performed 05/24/2022, BBCC cells documented as expired on 05/23/2022. d. patient testing performed 06/23/2022, BBCC cells documented as expired on 06/20/2022. 2. Staff interview with the Laboratory Technical Supervisor, and the BB General Supervisor, on 10/19/2022, at approximately 2pm, in the Hospital Conference Room, confirmed the above aforementioned statements. D6076 LABORATORY DIRECTOR CFR(s): 493.1441 The laboratory must have a director who meets the qualification requirements of 493. 1443 of this subpart and provides overall management and direction in accordance with 493.1445 of this subpart. This CONDITION is not met as evidenced by: A review of the Blood Bank Quality Control Record (BBCR), and staff interview, revealed the Laboratory Director (LD) failed to provide overall guidance and direction of the laboratory. The findings include: 1. The Laboratory Director failed to ensure the laboratory's BB quality control program was effective. ( refer to D6093). -- 2 of 3 -- D6093 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(5) The laboratory director must ensure that the quality control programs are established and maintained to assure the quality of laboratory services provided and to identify failures in quality as they occur. This STANDARD is not met as evidenced by: Based on review of the Blood Bank Quality Control Records (BBCR), signed as reviewed by the Laboratory Director (LD), revealed the LD failed to provide overall management and direction on the use of expired Blood Bank Check Cells (BBCC) for the testing of Group and Type, rH, and Crossmatch units of blood. The findings include: 1. A review of the BB QCR the BBCC used for the following days revealed the LD reviewed and signed QC records indicating the use of expired BBCC for the following days of testing. a. LD signoff on the use of expired cells for patient testing on 02/23/2022, BBCC expired on 02/21/2022. b. LD signoff on the use of expired cells for patient testing on 03/30/2022, BBCC expired on 03/28/2022. c. LD signoff on the use of expired cells for patient testing on 05/24/2022, BBCC expired on 05/23 /2022. d. LD signoff on the use of expired cells for patient testing on 06/23/2022, BBCC expired on 06/20/2022. 2. Interview with the Laboratory Technical Supervisor and the BB General Supervisor, on 10/19/2022, at approximately 2pm, in the hospital conference room, confirmed the above aforementioned statements. -- 3 of 3 --

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Survey - October 20, 2020

Survey Type: Standard

Survey Event ID: 5M9G11

Deficiency Tags: D5449 D0000

Summary:

Summary Statement of Deficiencies D0000 A Clinical Laboratory Improvement Amendments (CLIA) recertification survey was completed on October 23, 2020. The laboratory was not in compliance with applicable CLIA requirements found at 42 CFR 493.1 through 42 CFR 493.1780. The following deficiencies were cited: Ba A Clinical Laboratory Improvement Amendments (CLIA) recertification survey was completed on October 20, 2020. The laboratory was not in compliance with all applicable CLIA requirements found at 42 CFR 493.1 through 42 CFR 493.1780. The following deficiencies were cited: D5449 CONTROL PROCEDURES CFR(s): 493.1256(d)(3)(ii)(g) Unless CMS Approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing, the laboratory must-- At least once a day patient specimens are assayed or examined perform the following for-- Each qualitative procedure, include a negative and positive control material; (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on quality control (QC) document review and staff interview, the laboratory failed to document all control procedures performed as required. Findings include: 1 Review of Parasitology (Wet Preparation) and Potassium Hydroxide (KOH) QC, documented on the KOH/Wet Prep patient log sheet, revealed QC documentation was available at the time of survey for only 8/1/2020. 2. An interview with the laboratory manager in her office on 10/20/2020 at approximately 1:00 p.m. confirmed the aforementioned lack of Wet Preparation and KOH QC documentation. 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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Survey - October 23, 2018

Survey Type: Standard

Survey Event ID: TFZB11

Deficiency Tags: D0000 D3009

Summary:

Summary Statement of Deficiencies D0000 A Clinical Laboratory Improvement Amendments (CLIA) Initial survey was completed on October 23, 2018. The laboratory was not in compliance with applicable CLIA requirements found at 42 CFR 493.1 through 42 CFR 493.1780. The following deficiency was cited: D3009 FACILITIES CFR(s): 493.1101(c) The laboratory must be in compliance with applicable Federal, State, and local laboratory requirements. This STANDARD is not met as evidenced by: Based on review of the Laboratory Director's experience and credentials and staff interview, the laboratory failed to have a laboratory director who meets the State of Georgia licensure requirements. Findings include: 1. Review of education, experience and certification of the current laboratory director revealed the director does not meet the requirements for directing a high complexity laboratory licensed by the State of Georgia. 2. Interview with the laboratory supervisor and hospital administrator on October 23, 2018 at approximately 2:30 pm in the laboratory break room confirmed the laboratory director is not qualified to direct a high complexity laboratory in the State of Georgia. 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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