Filosa Childrens Clinic

CLIA Laboratory Citation Details

3
Total Citations
26
Total Deficiencyies
12
Unique D-Tags
CMS Certification Number 45D0991906
Address 1240 Business 83 Suite B, Mission, TX, 78572
City Mission
State TX
Zip Code78572
Phone956 585-6300
Lab DirectorPATRICIA FILOSA

Citation History (3 surveys)

Survey - December 29, 2022

Survey Type: Special

Survey Event ID: W82L11

Deficiency Tags: D0000 D2016 D2130 D6000 D6016 D0000 D2016 D2130 D6000 D6016

Summary:

Summary Statement of Deficiencies D0000 Based on a proficiency testing desk review survey performed on December 29, 2022, the laboratory was found to be out of compliance based on the following CONDITION LEVEL DEFICIENCIES: D2016 - 42 C.F.R. 493.803 Condition: Successful participation D6000 - 42 C.F.R. 493.1403 Condition: Laboratory Director, moderate complexity 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 review of the Certification and Survey Provider Enhanced Reporting (CASPER) Report 155 Individual Laboratory Profile and American Proficiency Institute evaluation reports, the laboratory failed to achieve satisfactory performance 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 -- in two of three consecutive testing events for the analyte White Blood Cell Differential, resulting in an initial unsuccessful performance. 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 review of the Certification and Survey Provider Enhanced Reporting (CASPER) Report 155 Individual Laboratory Profile and the American Proficiency Institute (API) Comparative Evaluations, the laboratory failed to achieve satisfactory performance for the analyte White Blood Cell Differential count in two of three consecutive testing events in 2022. The findings included: 1. Based on review of the Certification and Survey Provider Enhanced Reporting (CASPER) Report 155 Individual Laboratory Profile and the American Proficiency Institute (API) Comparative Evaluations, the laboratory received the following unsuccessful performance for the analyte White Blood Cell Differential count in the specialty of Hematology in two of three consecutive events: 2022 API 1st event 50% 2022 API 3rd event 33% Failure to achieve satisfactory performance for the same analyte in two consecutive events or two out of three consecutive testing events is unsuccessful performance. 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 desk review of the Certification and Survey Provider Enhanced Reporting (CASPER) Report 155 Individual Laboratory Profile and American Proficiency Institute evaluation reports, the laboratory director failed to ensure successful participation in an HHS approved proficiency testing program for analyte White Blood Cell Differential for two of three events in, resulting in an initial unsuccessful performance. 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; This STANDARD is not met as evidenced by: -- 2 of 3 -- Based on desk review of the Certification and Survey Provider Enhanced Reporting (CASPER) Report 155 Individual Laboratory Profile and American Proficiency Institute testing records, the laboratory director failed to ensure successful participation in a HHS approved proficiency testing program for analyte White Blood Cell Differential for two of three events in 2022, resulting in an initial unsuccessful performance. Refer to D2130. -- 3 of 3 --

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Survey - July 26, 2021

Survey Type: Standard

Survey Event ID: GCEU11

Deficiency Tags: D1001 D5401 D1001 D5401 D5413 D5429 D0000 D5413 D5429 D5481 D5781 D5481 D5781

Summary:

Summary Statement of Deficiencies D0000 Laboratory representatives were present at the entrance conference. The survey process was discussed. An opportunity for questions and comments was given. The exit conference was held with the laboratory representatives. The laboratory was found to be in substantial compliance for the specialties/subspecialties for which it was surveyed. The standard level deficiencies cited were discussed. The process for submitting the corrections was explained. CMS form 2567 will be emailed from the Texas Health and Human Services Commission, Health Facility Compliance Arlington Group. Note: The CMS-2567 (Statement of Deficiencies) is an official, legal document. All information must remain unchanged except for entering the

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Survey - November 28, 2018

Survey Type: Standard

Survey Event ID: JLFR11

Deficiency Tags: D1001 D5417 D5417

Summary:

Summary Statement of Deficiencies D1001 CERTIFICATE OF WAIVER TESTS CFR(s): 493.15(e) Laboratories eligible for a certificate of waiver must-- (1) Follow manufacturers' instructions for performing the test; and (2) Meet the requirements in subpart B, Certificate of Waiver, of this part. This STANDARD is not met as evidenced by: Based on surveyor observation, review of manufacturer's instructions, and confirmed in interview of facility personnel, the laboratory failed to follow the manufacturer's instructions for Siemens 10SG Multistix. The findings were: 1. Surveyor observation on November 28, 2018 09:45 hours in the laboratory revealed the following expired Siemens 10SG Multistix: Lot 704047 Expiration Date: 10-31-18 2. The manufacturer's instructions for the Siemens 10SG Multistix under, "Storage" stated, "Do not use the strps after their expiratio date." 3. The laboratory performed 11 patient tests from November 1, 2018 to November 28, 2018 when the test strips were expired. 4. An interview with the technical consultant on 11/28/2018 at 09:50 hours in the break room confirmed the findings. 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: Based on surveyor observation and confirmed in interview of facility personnel, the laboratory failed to ensure expired items were not available for use in patient testing. 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 -- The finding were: 1. Surveyor observation in the laboratory on 11/28/2018 at 09:45 hours during the initial tour of the laboratory revealed the following expired items: Universal Transport Medium (UTM) Lot 170307 Expiration Date: 09-07-2018 Quantity: 13 Purple Top Tubes (K2 EDTA) Lot 6124782 Expiration Date: 09-2017 Quantity: 38 Tiger Top (Serum Separator Tubes) Lot 6274792 Expiration Date: 09-30- 2017 Quantity: 97 2. Interview with the technical consultant on 11/28/2018 at 09:50 hours in the break room confirmed the findings. -- 2 of 2 --

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