Fortson Dermatology & Skin Care Center

CLIA Laboratory Citation Details

3
Total Citations
9
Total Deficiencyies
7
Unique D-Tags
CMS Certification Number 02D0931068
Address 2401 E 42nd Avenue, Suite 301, Anchorage, AK, 99508
City Anchorage
State AK
Zip Code99508
Phone(907) 563-3204

Citation History (3 surveys)

Survey - August 29, 2025

Survey Type: Standard

Survey Event ID: EVWF11

Deficiency Tags: D5217 D5477 D2000 D5417 D5481

Summary:

Summary Statement of Deficiencies D2000 ENROLLMENT AND TESTING OF SAMPLES CFR(s): 493.801 Each laboratory must enroll in a proficiency testing (PT) program that meets the criteria in subpart I of this part and is approved by HHS. The laboratory must enroll in an approved program or programs for each of the specialties and subspecialties for which it seeks certification. The laboratory must test the samples in the same manner as patients' specimens. For laboratories subject to 42 CFR part 493 published on March 14, 1990 (55 FR 9538) prior to September 1, 1992, the rules of this subpart are effective on September 1, 1992. For all other laboratories, the rules of this subpart are effective January 1, 1994. This CONDITION is not met as evidenced by: Based on record review and an interview with the Medical Assistant (MA2), the laboratory failed to enroll in proficiency testing (PT) in the subspecialty of mycology after the implementation of the new CLIA Proficiency Testing Final Rule (42 CFR Part 493 493.2 and 493.801 through 493.959) on January 1, 2025 requiring PT enrollment when testing for the presence or absence of fungi in culture. Findings include: 1. A request was made to review proficiency testing records for mycology testing using the Dermatophyte Test Media and no records could be provided. 2. An interview with MA2 8/29/25 at 12:00 PM confirmed that the laboratory was not enrolled in an approved PT program in 2025. 3. The laboratory reports performing approximately 100 fungal cultures annually. D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. 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 -- This STANDARD is not met as evidenced by: Based on a review of the Dermatophyte and KOH Proficiency Protocol, record review, and an interview with the Medical Assistant (MA2), the laboratory failed to verify the accuracy of fungal cultures in 2024, Potassium Hydroxide (KOH) preparations and dermatopathology slides at least twice annually in 2024 and 2025. Findings include: 1. A review of the Dermatology and KOH Proficiency Protocol states the laboratory uses peer review to monitor the accuracy of KOH skin scrapings, and Dermatophyte fungal culture testing twice a year and is documented in the office "green log book". 2. A request was made to review the documentation of the peer reviews for KOH preparations, fungal cultures, and dermatopathology slides, but documentation could not be provided. 3. An interview with MA2 on 8/29/25 at 12:00 PM confirmed these findings. 4. The laboratory reports 50 KOH skin scrapings, 100 fungal cultures, and 275 dermatopathology slides performed annually. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) (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 observations, record review, manufacturer's package insert, and an interview with the Medical Assistant (MA1), the laboratory failed to ensure the Hardy Dermatophyte Test Media (DTM) agar slants used for patient fungal cultures were inoculated before the manufacturer's expiration date listed on the vial in four of five patient cultures observed. Findings include: 1. Observation on 8/29/25 at 11:00 AM of patient DTM cultures in progress revealed that four of the five samples were inoculated after DTM lot # 650643 expired on 8/4/2025; patient samples were set up on 8/6, 8/7, and 8/8/2025. 2. A review of the Hardy Instructions for Use for DTM revealed the "product may be used and tested up to the expiration date on the product label". 3. An interview with MA2 on 8/29/25 at 12:00 PM confirmed these findings. 4. The laboratory reports performing approximately 100 fungal cultures annually. D5477 CONTROL PROCEDURES CFR(s): 493.1256(e)(4)(g) (e)(4) Before, or concurrent with the initial use-- (e)(4)(i) Check each batch of media for sterility if sterility is required for testing; (e)(4)(ii) Check each batch of media for its ability to support growth and, as appropriate, select or inhibit specific organisms or produce a biochemical response; and (e)(4)(iii) Document the physical characteristics of the media when compromised and report any deterioration in the media to the manufacturer. This STANDARD is not met as evidenced by: Based on review of procedure manuals, quality control (QC) records, and an interview with the Medical Assistant (MA2), the laboratory failed to check each lot number of DTM agar slants for its ability to support dermatophyte growth, inhibit normal flora and skin contaminants, and produce the media color change to indicate the presence /absence of dermatophytes, and to document these findings for each lot number of -- 2 of 3 -- commercially prepared DTM in one (1) of seven (7) lots of DTM received in 2024- 2025. Findings include: 1. A review of the procedure for DTM Fungal Cultures states "Quality Control is performed for each new lot number of DTM media". 2. A review of DTM QC logs for 2024 and 2025 revealed that lot number DTM 65064, in use at the time of the survey, did not have QC documented. 3. An interview with MA2 on 8 /29/25 at 12:00 PM confirmed the findings. 4. The laboratory reports performing approximately 100 fungal cultures annually. D5481 CONTROL PROCEDURES CFR(s): 493.1256(f)(g) (f) Results of control materials must meet the laboratorys and, as applicable, the manufacturers test system criteria for acceptability before reporting patient test results. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on review of the Dermatophyte Test Media (DTM) Quality Control (QC) procedure, QC records, and an interview with the Medical Assistant (MA2), the laboratory failed to document observations of the control microorganisms including the growth and color characteristics of the QC microorganisms, and the color changes of the DTM agar slant for 21 of 24 QC observations for DTM lots received in 2024 and 2025. Findings include: 1. A review of the laboratory Instructions for DTM QC Kit revealed the expected results include documentation of growth/no growth, a description of the growth, and media color changes to indicate the presence/absence of dermatophytes. 2. A review of seven (7) DTM QC logs from 2024 and 2025 showed that the description of QC microorganism growth and media color changes were not recorded for 21 of 24 control microorganisms. 3. An interview with MA2 on 8/29/25 at 12:00 PM confirmed these findings. 4. The laboratory reports performing approximately 100 fungal cultures annually. -- 3 of 3 --

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Survey - June 8, 2021

Survey Type: Standard

Survey Event ID: UDN611

Deficiency Tags: D5413 D5477 D5417

Summary:

Summary Statement of Deficiencies D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on review of refrigerator temperature logs and interview with the medical assistant, the laboratory failed to document

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Survey - February 28, 2019

Survey Type: Standard

Survey Event ID: PYE411

Deficiency Tags: D5601

Summary:

Summary Statement of Deficiencies D5601 HISTOPATHOLOGY CFR(s): 493.1273(a)(f) (a) As specified in 493.1256(e)(3), fluorescent and immunohistochemical stains must be checked for positive and negative reactivity each time of use. For all other differential or special stains, a control slide of known reactivity must be stained with each patient slide or group of patient slides. Reactions of the control slide with each special stain must be documented. (f) The laboratory must document all control procedures performed, as specified in this section. This STANDARD is not met as evidenced by: Based on surveyor review of patient test records and Laboratory Director interview, the laboratory did not document the stain quality for each patient slide or group of patient slides. Findings: 1. The laboratory sends patient tissue and biopsy samples to a dermatopathology laboratory (Dermpath Lab of Central States (DLCS)) for mounting and staining, and receives stained slides back for reading and reporting. 2. The laboratory director stated, during an interview on 2/28/2019 at 12:45 pm, that the laboratory has not been documenting the stain quality of these slides. 3. The laboratory performs approximately 270 patient slides annually. 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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