Family Care Clinic Of Ripley

CLIA Laboratory Citation Details

3
Total Citations
8
Total Deficiencyies
7
Unique D-Tags
CMS Certification Number 25D1061604
Address 1331 City Ave N, Ripley, MS, 38663
City Ripley
State MS
Zip Code38663
Phone662 993-9336
Lab DirectorERIC HARDING

Citation History (3 surveys)

Survey - September 30, 2024

Survey Type: Special

Survey Event ID: 2FPL11

Deficiency Tags: D2016 D2130 D6000 D6016 D0000

Summary:

Summary Statement of Deficiencies D0000 The following deficiencies are a result of a desk review of proficiency testing scores obtained from the national database and verified with the proficiency testing company. The facility was found to be out of compliance with the conditions of the CLIA program. The following CONDITION LEVEL DEFICIENCIES were found to be out of compliance: D2016 - 42 C.F.R. 493.803 Condition: Successful participation (proficiency testing) D6000 - 42 C.F.R. 493.1403 Condition: Laboratories performing moderate complexity testing; laboratory director D2016 SUCCESSFUL PARTICIPATION CFR(s): 493.803(a)(b)(c) (a) Each laboratory performing nonwaived testing must successfully participate in a proficiency testing program approved by CMS, if applicable, as described in subpart I of this part for each specialty, subspecialty, and analyte or test in which the laboratory is certified under CLIA. (b) Except as specified in paragraph (c) of this section, if a laboratory fails to participate successfully in proficiency testing for a given specialty, subspecialty, analyte or test, as defined in this section, or fails to take remedial action when an individual fails gynecologic cytology, CMS imposes sanctions, as specified in subpart R of this part. (c) If a laboratory fails to perform successfully in a CMS- approved proficiency testing program, for the initial unsuccessful performance, CMS may direct the laboratory to undertake training of its personnel or to obtain technical assistance, or both, rather than imposing alternative or principle sanctions except when one or more of the following conditions exists: (1) There is immediate jeopardy to patient health and safety. (2) The laboratory fails to provide CMS or a CMS agent with satisfactory evidence that it has taken steps to correct the problem identified by the unsuccessful proficiency testing performance. (3) The laboratory has a poor compliance history. This CONDITION is not met as evidenced by: Based on surveyor desk review of the laboratory proficiency testing (PT) 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 -- (graded copies from the American Proficiency Institute (API) and the CASPER reports 0153D/0155D from the Centers for Medicare and Medicaid Services data system) on 9/30/2024, the laboratory failed to achieve satisfactory performance in two of three testing events (2023-Event 3, and 2024-Event 2) resulting in unsuccessful participation in Hematology for ERYTHROCYTE COUNT (RBC) and HEMOGLOBIN. Refer to D2130. D2130 HEMATOLOGY CFR(s): 493.851(f) Failure to achieve satisfactory performance for the same analyte in two consecutive events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on surveyor desk review of the laboratory proficiency testing (PT) records (graded copies from the American Proficiency Institute (API) and CASPER reports 0153D/0155D from the Centers for Medicare and Medicaid Services data system) on 9 /30/2024, the laboratory has not successfully performed proficiency testing for ERYTHROCYTE COUNT (RBC( and HEMOGLOBIN in two of three testing events. Findings include: A review of the laboratory records from the American Proficiency Institute (API) and the CMS CASPER reports 0153D/0155D revealed the laboratory scored the following for ERYTHROCYTE COUNT (RBC) and HEMOGLOBIN: ERYTHROCYTE COUNT (RBC): Year 2023-3rd Event 0% Year 2024-2nd Event: 60% HEMOGLOBIN: Year 2023-3rd Event 0% Year 2024-2nd Event 60% D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR CFR(s): 493.1403 The laboratory must have a director who meets the qualification requirements of 493. 1405 of this subpart and provides overall management and direction in accordance with 493.1407 of this subpart. This CONDITION is not met as evidenced by: Based on surveyor desk review of the laboratory proficiency testing records (graded copies from the American Proficiency Institute (API) and CASPER reports 0153D /0155D from the Centers for Medicare and Medicaid Services data system) on 9/30 /2024, the laboratory director failed to provide overall management and direction of the laboratory services. Refer to D6016. D6016 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(4)(i) The laboratory director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, and record and report test results promptly, accurate, and proficiently and for assuring compliance with the applicable regulations. (e) The laboratory director must-- (e)(4)(i) Ensure that the proficiency testing samples are tested as required under Subpart H of this part; -- 2 of 3 -- This STANDARD is not met as evidenced by: Based on surveyor desk review of the laboratory proficiency testing records (graded copies from the American Proficiency Institute (API) and CASPER report 0153D /0155D from the Centers for Medicare and Medicaid Services data system) on 9/30 /2024, the laboratory director failed to ensure the overall quality of the laboratory services provided. The laboratory director failed to ensure successful participation in an HHS approved proficiency testing program. Refer to D2130. -- 3 of 3 --

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Survey - September 20, 2023

Survey Type: Standard

Survey Event ID: QYLK11

Deficiency Tags: D0000

Summary:

Summary Statement of Deficiencies D0000 Family Care Clinic of Ripley is in compliance with 42 CFR Part 493, all subparts, requirements for clinical laboratories. No deficiencies were cited. 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 - January 18, 2022

Survey Type: Standard

Survey Event ID: QT5N11

Deficiency Tags: D3037 D6049

Summary:

Summary Statement of Deficiencies D3037 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(4) Proficiency testing records. Retain all proficiency testing records for at least 2 years. This STANDARD is not met as evidenced by: Based on review of the laboratory proficiency testing records from 2019 and 2020 and confirmation with TP (testing personnel) #1 at 5:30 p.m. on the day of survey, the laboratory failed to retain all proficiency records to include but not limited to results, attestation statements, and analyzer printouts. Findings include: 1. Review of records for the 1st, 2nd and 3rd proficiency testing events of 2020 and 2021 revealed the laboratory did not retain the following records: a. Report sheet/submitted result sheets for 1st, 2nd and 3rd events of 2020 and 2021. b. Attestation statements for 1st, 2nd and 3rd events of 2020 and 2021 2. Interview with TP #1 at 5:30 p.m. on 1/18/21 confirmed that the listed proficiency records were not retained after the completion of each proficiency event. D6049 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(8)(iii) The procedures for evaluation of the competency of the staff must include, but are not limited to review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records. This STANDARD is not met as evidenced by: Based on review of laboratory testing records from 9/24/19 through 1/18/22 and interview with TP #1 and the Technical Consultant (TC)/Clinic Owner listed on the Centers of Medicare & Medicaid Services 209 form at 2:30 p.m. on 1/18/22, the TC failed to document as reviewed quality control records, maintenance forms, 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 -- calibration reports, and temperature charts. Findings Include: 1. Review of the laboratory records from 9/24/19 through 1/18/22 revealed the following records were not documented as reviewed by the technical consultant: a. Boule Medonic M Series hematology maintenance from 9/25/19 through 1/18/22. b. Boule Medonic M Series hematology quality control from 10/1/19 through 1/18/22. c. Boule Medonic M Series hematology calibration records on 9/19/19, 8/27/20, 7/28/21, 1/6/22, 1/11/22 d. Temperature records (room, refrigerator, freezer) from 10/1/19 through 1/18/22 2. Interview with the TC/Clinic Owner (by phone) at 6:30 p.m. on 1/19/22 and TP #1 at 2:30 p.m. on 1/18/22 confirmed there was no documented review of these records by the TC. -- 2 of 2 --

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