Family Care Walk In Clinic, Inc

Summary Statement of Deficiencies D3011 FACILITIES CFR(s): 493.1101(d) Safety procedures must be established, accessible, and observed to ensure protection from physical, chemical, biochemical, and electrical hazards, and biohazardous materials. This STANDARD is not met as evidenced by: Based on observations and staff interviews, the laboratory failed to provide adequate eyewash for testing personnel. The findings include: 1. During the laboratory tour on 11/17/2025 at 10:15 a.m., an eyewash station sign was observed above the sink next to the Emerald CBC instrument. No eyewash station was present. It was observed that the CBC instrument waste was draining into sink. 2. An interview with Testing Person One on 11/17/2025 at 10:15 a.m. revealed that the faucet sprayer was intended to be used as an eyewash station. 3. The Technical Consultant confirmed the findings on 11 /17/2025 at 10:20 a.m. 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 --

Summary Statement of Deficiencies D5403 PROCEDURE MANUAL CFR(s): 493.1251(b) The procedure manual must include the following when applicable to the test procedure: (1) Requirements for patient preparation; specimen collection, labeling, storage, preservation, transportation, processing, and referral; and criteria for specimen acceptability and rejection as described in 493.1242. (2) Microscopic examination, including the detection of inadequately prepared slides. (3) Step-by-step performance of the procedure, including test calculations and interpretation of results. (4) Preparation of slides, solutions, calibrators, controls, reagents, stains, and other materials used in testing. (5) Calibration and calibration verification procedures. (6) The reportable range for test results for the test system as established or verified in 493.1253. (7) Control procedures. (8)