Gem State Dermatology

CLIA Laboratory Citation Details

4
Total Citations
18
Total Deficiencyies
16
Unique D-Tags
CMS Certification Number 13D0935092
Address 388 E Parkcenter Blvd, Boise, ID, 83712
City Boise
State ID
Zip Code83712
Phone(208) 424-9101

Citation History (4 surveys)

Survey - January 17, 2024

Survey Type: Standard

Survey Event ID: DG1A11

Deficiency Tags: D2009 D5211 D5423 D5473 D6076 D6082 D6091 D6093 D6094 D6103 D6106 D6120

Summary:

Summary Statement of Deficiencies 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 a review of proficiency testing (PT) records from Wisconsin State Laboratory of Hygiene (WSLH) and an interview with the laboratory lead on 1/17 /2024, the laboratory failed to sign PT attestations for 2023. The findings include: 1. A review of PT records from WSLH for the two events in 2023 identified that the laboratory director and testing personnel failed to sign the attestation statements for potassium hydroxide (KOH) slide examination testing for all 2023 events. 2. An interview with the laboratory lead on 1/17/2024 at 8:29 am confirmed that the laboratory director and testing personnel failed to sign attestation statements for all KOH PT 2023 events. 3. The laboratory reports performing 1,000 KOH slide examination tests annually. D5211 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(a) The laboratory must review and evaluate the results obtained on proficiency testing performed as specified in subpart H of this part. This STANDARD is not met as evidenced by: Based on a review of proficiency testing (PT) records from American Academy of Family Physicians (AAFP) and Wisconsin State Laboratory of Hygiene (WSLH) and an interview with the laboratory lead on 1/17/2024, the laboratory director failed to Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 6 -- review PT results for 2022 and 2023. The findings include: 1. A review of PT records from AAFP for the three events in 2022 identified that the laboratory director failed to review and evaluate graded results for potassium hydroxide (KOH) slide examination testing for all 2022 events. 2. A review of PT records from WSLH for the two events in 2023 identified that the laboratory director failed to review and evaluate graded results for KOH testing for all 2023 events. 3. An interview with the laboratory lead on 1/17/2024 at 8:29 am confirmed that the laboratory director failed to review and evaluate the graded KOH PT results for all events in 2022 and 2023. 4. The laboratory reports performing 1,000 KOH slide examination tests annually. 5. This is a repeat deficiency from the 2/17/2022 survey. D5423 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE CFR(s): 493.1253(b)(2) Each laboratory that modifies an FDA-cleared or approved test system, or introduces a test system not subject to FDA clearance or approval (including methods developed in-house and standardized methods such as text book procedures), or uses a test system in which performance specifications are not provided by the manufacturer must, before reporting patient test results, establish for each test system the performance specifications for the following performance characteristics, as applicable: (2)(i) Accuracy. (2)(ii) Precision. (2)(iii) Analytical sensitivity. (2)(iv) Analytical specificity to include interfering substances. (2)(v) Reportable range of test results for the test system. (2)(vi) Reference intervals (normal values). (2)(vii) Any other performance characteristic required for test performance. This STANDARD is not met as evidenced by: Based on a lack of documentation of verification of performance specifications for digital pathology and an interview with the laboratory lead on 1/17/2024, the laboratory failed to ensure test performance specifications were established and verified before patient testing began in October 2022. The findings include: 1. A lack of documentation for the verification of performance specifications for digital pathology identified that the laboratory failed to establish diagnostic concordance between digital images and glass slides before converting to digital pathology in October 2022. 2. A lack of documentation for the verification of performance specifications for digital pathology identified that the laboratory failed to confirm that digital images and patient information transmitted by the reference laboratory were received in their entirety and accurate. 3. An interview with the laboratory lead on 1/17 /2024 at 8:27 am confirmed the above findings. 4. The laboratory reports performing 648 dermatopathology cases annually. D5473 CONTROL PROCEDURES CFR(s): 493.1256(e)(2)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e) (2) Each day of use (unless otherwise specified in this subpart), test staining materials for intended reactivity to ensure predictable staining characteristics. Control materials for both positive and negative reactivity must be included, as appropriate. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on a review of patient reports and an interview with the laboratory lead on 1/17 -- 2 of 6 -- /2024, the laboratory failed to have documentation of Hematoxylin and Eosin (H&E) stain quality control (QC) since October 2022. The findings include: 1. A review of patient reports identified that the laboratory failed to document QC of H&E stained slides after converting to digital pathology in October 2022. 2. An interview with the laboratory lead on 1/17/2024 at 9:08 am confirmed that the laboratory failed to have documentation of H&E stain QC since October 2022. 3. The laboratory reports performing 648 dermatopathology cases annually. D6076 LABORATORY DIRECTOR CFR(s): 493.1441 The laboratory must have a director who meets the qualification requirements of 493. 1443 of this subpart and provides overall management and direction in accordance with 493.1445 of this subpart. This CONDITION is not met as evidenced by: Based on a review of proficiency testing (PT) documents from American Academy of Family Physicians (AAFP) and Wisconsin State Laboratory of Hygiene (WSLH), the Centers for Medicare and Medicaid Services (CMS) 209 personnel form, training and competency assessment records, laboratory policies and procedures, a lack of documentation and interviews with the laboratory lead on 1/17/2024, the laboratory director failed to ensure that digital pathology verifications were performed, that PT graded results were reviewed, that testing personnel had appropriate training and were competent to perform testing, to ensure policies and procedures were available for testing personnel to follow, that quality controls were documented for patient result reporting and that the laboratory had a quality assurance plan. See D6082, D6091, D6093, D6094, D6103 and D6106. D6082 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(1) The laboratory director must ensure that testing systems developed and used for each of the tests performed in the laboratory provide quality laboratory services for all aspects of test performance, which includes the preanalytic, analytic, and postanalytic phases of testing. This STANDARD is not met as evidenced by: Based on a lack of documentation for the verification of performance specifications for digital pathology and an interview with the laboratory lead on 1/17/2024, the laboratory director failed to ensure test performance specifications were established and verified before beginning patient testing in October 2022. The findings include: 1. A lack of documentation for the verification of performance specifications for digital pathology identified that the laboratory failed to establish diagnostic concordance between digital images and glass slides and verify that digital images and patient information transmitted by the reference laboratory was accurate before converting to digital pathology in October 2022. See D5423 2. An interview with the laboratory lead on 1/17/2024 at 8:27 am confirmed the above findings. 3. The laboratory reports performing 648 dermatopathology cases annually. D6091 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(iii) -- 3 of 6 -- The laboratory director must ensure all proficiency testing reports received are reviewed by the appropriate staff to evaluate the laboratory's performance and to identify any problems that require

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Survey - February 17, 2022

Survey Type: Standard

Survey Event ID: 8VOF11

Deficiency Tags: D2015 D5211

Summary:

Summary Statement of Deficiencies 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 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 a review of proficiency testing (PT) records from American Academy of Family Physicians (AAFP) and an interview with the clinic manager on 2/17/2022, the laboratory failed to document and retain PT result forms and attestation forms for 2021. The findings include: 1. A review of PT records from AAFP for the three events in 2021 identified that the laboratory failed to document and retain the reported results for potassium hydroxide (KOH) testing for all 2021 events. 2. A review of PT records from AAFP for the three events in 2021 identified that the laboratory failed to retain the signed attestation forms for all 2021 events. 3. An interview with the clinic manager on 2/17/2022 at 10:15 am confirmed the above findings. 4. The laboratory reports performing 117 KOH tests annually. D5211 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(a) The laboratory must review and evaluate the results obtained on 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 -- performed as specified in subpart H of this part. This STANDARD is not met as evidenced by: Based on a review of proficiency testing (PT) records from American Academy of Family Physicians (AAFP) and an interview with the clinic manager on 2/17/2022, the laboratory director failed to review PT results for 2021. The findings include: 1. A review of PT records from AAFP for the three events in 2021 identified that the laboratory director failed to review and evaluate the results for potassium hydroxide (KOH) testing for all 2021 events. 2. An interview with the clinic manager on 2/17 /2022 at 10:15 confirmed that the laboratory director failed to review and evaluate the graded KOH PT results for all three events in 2021. 3. The laboratory reports performing 117 KOH tests annually. -- 2 of 2 --

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Survey - August 3, 2020

Survey Type: Standard

Survey Event ID: 0WMO11

Deficiency Tags: D5217 D5401 D6046

Summary:

Summary Statement of Deficiencies 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. This STANDARD is not met as evidenced by: Based on record review and interview with the laboratory medical assistant the laboratory failed to document the accuracy of potassium hydroxide (KOH) and scabies microscopic examination at least twice annually. Findings: 1. A record review revealed the laboratory failed to document the accuracy of KOH and scabies microscopic examination, at least semiannually, for the detection of fungal elements and scabies since the last survey on February 27, 2018. 2. An interview on August 3, 2020 at 2:00 PM with the laboratory medical assistant, confirmed the laboratory failed to document the accuracy of KOH and scabies microscopic examination. D5401 PROCEDURE MANUAL CFR(s): 493.1251(a) A written procedures manual for all tests, assays, and examinations performed by the laboratory must be available to, and followed by, laboratory personnel. Textbooks may supplement but not replace the laboratory's written procedures for testing or examining specimens. This STANDARD is not met as evidenced by: Based on review of procedures, observation and interview with the laboratory medical assistant the laboratory failed to follow their written procedure for KOH testing. Findings: 1. In the laboratory's written procedure for KOH examination, page one, it states to use 20% KOH 2. Observation of reagents in the laboratory revealed that there 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 -- was only 10% KOH, lot 9218 expiration 08/06/2021, available for use at the time of the survery. 3. An interview on August 3, 2020 at 3:00 PM, with the laboratory medical assistant, confirmed that the concentration of KOH that was being used by the laboratory for KOH examination was 10% and that was the only concentration of KOH at the facility. 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 with the laboratory medical assistant, the technical consultant failed to evaluate the testing personnel for their competency to perform scabies microscopic examination. Findings: 1. A record review revealed the laboratory failed to document the competency of scabies microscopic examination, for four out of four providers. 2. An interview on August 3, 2020 at 2:30 PM, with the laboratory medical assistant, confirmed that the laboratory director and 3 physician assistants perform scabies microscopic examination and that they had no documentation of competency. -- 2 of 2 --

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Survey - February 27, 2018

Survey Type: Standard

Survey Event ID: Y2RP11

Deficiency Tags: D5217

Summary:

Summary Statement of Deficiencies 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. This STANDARD is not met as evidenced by: Based on record review and an interview with the laboratory medical assistant, the laboratory failed to verify the accuracy of potassium hydroxide (KOH) and Tzank smears at least twice annually since the last survey on April 21, 2016. Findings: 1. A record review revealed the laboratory failed to document the accuracy of KOH and Tzank smears, at least semiannually, for the detection of fungal elements and herpes cells since the last survey on April 21, 2016. 2. An interview on February 27, 2018 at 10:00 AM, with the laboratory medical assistant, confirmed the laboratory failed to document the accuracy of KOH and Tzank smears. 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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