Five Valleys Urology

CLIA Laboratory Citation Details

3
Total Citations
21
Total Deficiencyies
10
Unique D-Tags
CMS Certification Number 27D0707089
Address 2875 Tina Avenue Suite 101, Missoula, MT, 59808
City Missoula
State MT
Zip Code59808
Phone406 728-3366
Lab DirectorBRIAN KELLY

Citation History (3 surveys)

Survey - January 13, 2025

Survey Type: Standard

Survey Event ID: 97Q811

Deficiency Tags: D5400 D5403 D5413 D5415 D5417 D5400 D5403 D5413 D5415 D5417

Summary:

Summary Statement of Deficiencies 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 a record review of endocrinology, the manufacturer's instructions, and the laboratory's policy and procedure, the laboratory failed to include in their procedures a course of action to take if a test system becomes inoperable; a quality control procedure that includes the number and frequency of testing controls, criteria of acceptability, and the

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Survey - October 12, 2021

Survey Type: Standard

Survey Event ID: QAXQ11

Deficiency Tags: D5403 D5403

Summary:

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)

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Survey - March 13, 2019

Survey Type: Standard

Survey Event ID: OUSM11

Deficiency Tags: D2009 D2015 D5209 D5209 D6046 D0000 D2009 D2015 D6046

Summary:

Summary Statement of Deficiencies D0000 Based on an on-site recertification survey conducted on 3/13/18, deficiencies were cited for Five Valleys Urology in Missoula, MT. 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 record review and interview, the laboratory director and testing personnel failed to sign 18 of 18 attestation statements in 2017 and 2018. The findings include: 1. A review on 3/13/19 at 2:00 p.m. of the American Association of Bioanalysts (AAB) proficiency testing documentation lacked attestation signatures for urinalysis, clinical microscopy, and special chemistry for events 1, 2, and 3 of 2017 and 2018. 2. On 3/13/19 at 2:00 p.m., staff member A stated the laboratory did not know to sign the attestation statements. 3. A review on 3/13/19 at 4:00 p.m. of the laboratory checklist for verifying attestation statements were signed was last completed for event 3 of 2016. D2015 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(5)(6) (5) The laboratory must document the handling, preparation, processing, examination, and each step in the testing and reporting of results for all proficiency testing samples. The laboratory must maintain a copy of all records, including a copy of the proficiency testing program report forms used by the laboratory to record proficiency testing results including the attestation statement provided by the PT program, signed by the analyst and the laboratory director, documenting that proficiency 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 -- samples were tested in the same manner as patient specimens, for a minimum of two years from the date of the proficiency testing event. (6) PT is required for only the test system, assay, or examination used as the primary method for patient testing during the PT event. This STANDARD is not met as evidenced by: Based on record review and interview, the laboratory failed to document handling, preparation, processing, examination, and each step in the testing and reporting of results for 18 of 18 proficiency testing samples in 2017 and 2018. The findings include: 1. A review on 3/13/19 at 2:00 p.m. of the American Association of Bioanalysts (AAB) proficiency testing documentation lacked handling, preparation, processing, examination, testing, and reporting records for urinalysis, clinical microscopy, and special chemistry specimens for events 1, 2, and 3 of 2017 and 2018. 2. On 3/13/19 at 4:00 p.m., staff member B stated the proficiency testing documentation was not located in the laboratory. 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. This STANDARD is not met as evidenced by: Based on record review and interview, the laboratory failed to establish and follow a written policy to assess employee competency from 4/17/17 through 3/13/19. The findings include: 1. On 3/13/19 at 2:45 p.m., staff member A stated initial training and competency assessments for the current testing personnel were not documented. 2. A review on 3/13/19 at 3:45 p.m. of the competency assessments on file lacked competency assessments for four testing personnel (staff members A, D, E, and F). 3. A review on 3/13/19 at 3:15 p.m. of the Five Valleys Urology Policy and Procedure binder lacked a written employee competency policy. D6046 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(8) (b) The technical consultant is responsible for-- (b)(8) Evaluating the competency of all testing personnel and assuring that the staff maintain their competency to perform test procedures and report test results promptly, accurately and proficiently. This STANDARD is not met as evidenced by: Based on record review and interview, the technical consultant failed to evaluate the competency of four of four testing personnel. The findings include: 1. On 3/13/19 at 2: 45 p.m., staff member A stated initial training and competency assessments for testing personnel was not documented. 2. A review on 3/13/19 at 3:45 p.m. of the competency assessments on file lacked competency assessments for four testing personnel in 2018. a. Staff members A, D, E, and F. -- 2 of 2 --

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