Grace Primary Care A Division Of Summit Medical

CLIA Laboratory Citation Details

3
Total Citations
7
Total Deficiencyies
7
Unique D-Tags
CMS Certification Number 44D1004150
Address 950 Baker Hwy, Ste 4, Huntsville, TN, 37756-4169
City Huntsville
State TN
Zip Code37756-4169
Phone844 655-1100
Lab DirectorTIMOTHY SMITH

Citation History (3 surveys)

Survey - June 20, 2024

Survey Type: Standard

Survey Event ID: 0BYM11

Deficiency Tags: D5401

Summary:

Summary Statement of Deficiencies 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 observation of the laboratory, review of the laboratory procedure manual, review of calibration verification records, and staff interview, the laboratory failed to follow its written policy for calibration verification frequency in 2024. The findings include: 1. Observation of the laboratory on 06.20.2024 at 9:00 a.m. revealed a Cell- Dyn Emerald hematology analyzer (Serial Number: 8394) in use for patient Complete Blood Count (CBC) testing. 2. A review of the laboratory's hematology procedure revealed calibration verification is performed and documented at least every six months. 3. A review of laboratory calibration verification records revealed calibration verification was not performed every six months in 2024. 4. Interview on 06.20.2024 at 10:40 a.m. with the site manager confirmed the above survey findings. 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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Survey - May 17, 2021

Survey Type: Special

Survey Event ID: P09O11

Deficiency Tags: D2016 D2130

Summary:

Summary Statement of Deficiencies 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: =================================== Hematology: The laboratory failed to maintain satisfactory participation in two consecutive events for the Red Blood Cell (RBC) analyte resulting in the initial unsuccessful proficiency testing (PT) occurrence for RBC. (Refer to D2130) =================================== D2130 HEMATOLOGY CFR(s): 493.851(f) Failure to achieve satisfactory performance for the same analyte in two consecutive 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 -- events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: =================================== Based on a desk review of the CMS CASPER Report 0155D and the laboratory's 2020/2021 Proficiency Testing (PT) performance summary records from the American Proficiency Institute (API) Proficiency Testing program, the laboratory failed to maintain satisfactory performance for the Red Blood Cell (RBC) analyte in the 3rd event 2020 and 1st event 2021, resulting in the initial unsuccessful PT occurrence. The findings include: 1. A review of the CMS 0155D report revealed unsatisfactory RBC analyte scores of 60% for the 3rd event of 2020 and 40% for the 1st event of 2021. 2. A review of the laboratory's API Proficiency Testing records revealed the 2020 3rd event had unacceptable performance for RBC resulting in a 60% score. 3. A review of the laboratory's API Proficiency Testing records revealed the 2021 1st event had unacceptable performance for RBC resulting in a 40% score, resulting in the initial unsuccessful PT occurrence. =================================== -- 2 of 2 --

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Survey - January 24, 2018

Survey Type: Standard

Survey Event ID: 541M11

Deficiency Tags: D2007 D2009 D5439 D6046

Summary:

Summary Statement of Deficiencies D2007 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) The samples must be examined or tested with the laboratory's regular patient workload by personnel who routinely perform the testing in the laboratory, using the laboratory's routine methods This STANDARD is not met as evidenced by: _____________________________________ Based on review of the Proficiency Testing (PT) Attestation records for 2016 and 2017, documented competencies for 11 of 12 testing personnel and upon interview with the Primary and Assistant Laboratory Leaders, determined the PT samples were not rotated among all testing personnel as listed on the Laboratory Personnel Report Form 209 for the patient testing they are currently performing as noted on their competency forms. The findings include: 1. A review of the 2016 and 2017 PT attestation records for Chemistry and Microbiology revealed only 1 of 4 testing persons showed participation in testing PT samples. 2. A review of the 2016 and 2017 PT attestation records for CBC testing revealed only 4 of 11 testing persons showed participation in testing PT samples. 3. A review of documented competencies for 2016 and 2017 showed 4 of 12 testing personnel competent for performing Chemistry and Microbiology testing and 11 of 12 testing personnel competent for performing CBC testing. 4. An interview with the Primary Laboratory Leader at approximately 1:00 p.m. January 24, 2018 confirmed that all testing personnel had not been participating in the PT for which they are currently performing patient testing in. ______________________________ 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 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 -- laboratory's routine methods. This STANDARD is not met as evidenced by: ____________________________________ Based on lack of director's signature on attestation sheets for Hematology testing events 3 of 2016 and 1 of 2017 and interview with the Primary Laboratory Leader, the Laboratory Director failed to attest to integration of proficiency testing (PT) samples into the routine patient workload for these 2 events. The findings include: 1. Lack of director's signature on attestation sheets for Hematology testing events 3 of 2016 and 1 of 2017. 2. Interview at approximately 12:00 p.m. January 24, 2018 with the Primary Laboratory Leader confirmed the Laboratory Director failed to attest to integration of PT samples into the routine patient workload by lack of signature on events 3 of 2016 and 1 of 2017. ____________________________________ D5439 CALIBRATION AND CALIBRATION VERIFICATION CFR(s): 493.1255(b) Unless otherwise specified in this subpart, for each applicable test system the laboratory must do the following: Perform and document calibration verification procedure - (b)(1) Following the manufacturer's calibration verification instructions; (b)(2) Using the criteria verified or established by the laboratory under 493.1253(b)(3) -- (b)(2)(i) Including the number, type, and concentration of the materials, as well as acceptable limits for calibration verification; and (b)(2)(ii) Including at least a minimal (or zero) value, a mid-point value, and a maximum value near the upper limit of the range to verify the laboratory's reportable range of test results for the test system; and (b)(3) At least once every 6 months and whenever any of the following occur: (b)(3)(i) A complete change of reagents for a procedure is introduced, unless the laboratory can demonstrate that changing reagent lot numbers does not affect the range used to report patient test results, and control values are not adversely affected by reagent lot number changes. (b)(3)(ii) There is major preventive maintenance or replacement of critical parts that may influence test performance. (b)(3)(iii) Control materials reflect an unusual trend or shift, or are outside of the laboratory's acceptable limits, and other means of assessing and correcting unacceptable control values fail to identify and correct the problem. (b)(3)(iv) The laboratory's established schedule for verifying the reportable range for patient test results requires more frequent calibration verification. This STANDARD is not met as evidenced by: ___________________________________ Based on a review of the Laboratory's protocol for performing the Calibration Verification every 6 months on the Hematology analyzer, lack of calibration verification documentation since 5/20/16 and an interview with the Primary Laboratory Leader, determined the laboratory failed to ensure calibration verification was performed every six months per protocol. The findings include: 1. Review of the Laboratory's protocol for performing calibration verification every 6 months on the Hematology analyzer. 2. Lack of calibration verification documentation since 5/20/16. 2. Interview at approximately 2: 00 p.m. January 24, 2018 with the Primary Laboratory Leader confirmed the laboratory failed to follow protocol for performing calibration verification on the Hematology analyzer every 6 months since 5/20/16. ___________________________________ -- 2 of 3 -- 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 lack of the 6 competency assessment criteria upon review of 12 of 12 testing personnel competency evaluations and interview with the Primary and Assistant Laboratory Leaders, determined the Technical Consultant failed to include all 6 required competency assessment criteria for 2016 and 2017. The findings include: 1. Upon review of competency evaluations for 12 of 12 testing personnel, it was revealed they lacked the 6 required competency criteria for 2016 and 2017. 2. An interview at approximately 1:00 p.m. January 24, 2018 with the Primary and Assistant Laboratory Leaders, confirmed the Technical Consultant failed to include the 6 criteria for assessing competency for 12 of 12 testing personnel for the two year period. ______________________________________ -- 3 of 3 --

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