Family Doctor Clinic Of Thibodaux

CLIA Laboratory Citation Details

1
Total Citation
48
Total Deficiencyies
24
Unique D-Tags
CMS Certification Number 19D0459641
Address 804 South Acadia Drive, Thibodaux, LA, 70301
City Thibodaux
State LA
Zip Code70301
Phone(985) 446-2680

Citation History (1 survey)

Survey - April 13, 2023

Survey Type: Standard

Survey Event ID: QR5K11

Deficiency Tags: D0000 D2009 D5209 D5209 D5291 D5401 D5403 D5421 D5421 D5793 D6013 D6016 D6018 D6021 D6031 D6032 D6030 D6031 D6032 D6040 D6042 D6046 D0000 D2009 D5211 D5211 D5291 D5401 D5403 D5793 D6013 D6016 D6018 D6021 D6029 D6030 D6029 D6040 D6042 D6046 D6049 D6050 D6051 D6052 D6051 D6049 D6050 D6052

Summary:

Summary Statement of Deficiencies D0000 A Validation survey was performed April 12, 2023 through April 13, 2023 at Family Doctor Clinic of Thibodaux, CLIA ID # 19D0459641. The laboratory was found in compliance with 42 CFR 493 Requirements for Laboratories; however, standard level deficiencies were cited. D2009 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) The individual testing or examining the samples and the laboratory director must attest to the routine integration of the samples into the patient workload using the laboratory's routine methods. This STANDARD is not met as evidenced by: Based on review of proficiency testing records and interview with personnel, the laboratory failed to ensure the Laboratory Director and Testing Personnel signed the proficiency attestation statements for one (1) of seven (7) proficiency testing (PT) events. Findings: 1. Review of the College of American Pathologists (CAP) proficiency testing records for 2021, 2022, and 2023 revealed the following one (1) attestation statement did not include the signature of the Laboratory Director or Testing Personnel: ID3-A 2022 Nucleic Acid Amplification, Respiratory Limited Survey 2. Interview on April 12, 2023 at 3:35 PM, the Technical Consultant confirmed the attestation was not signed. 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. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 12 -- This STANDARD is not met as evidenced by: I. Based on review of policies and procedures, personnel records, and interview with personnel, the laboratory failed to establish written policies and procedures to assess competency for testing personnel. Findings: 1. Review of the laboratory's policy and procedure manual revealed the laboratory did not have a policy addressing competency assessment to include, but not limited to,

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