Granger Medical Clinic Dermatology

CLIA Laboratory Citation Details

2
Total Citations
6
Total Deficiencyies
3
Unique D-Tags
CMS Certification Number 46D2013546
Address 9001 S 3200 W, Unit 2, West Jordan, UT, 84088
City West Jordan
State UT
Zip Code84088
Phone(801) 965-2799

Citation History (2 surveys)

Survey - January 13, 2021

Survey Type: Standard

Survey Event ID: QQNU11

Deficiency Tags: D5403 D5787 D5403 D5787

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 - August 16, 2018

Survey Type: Standard

Survey Event ID: D7WZ11

Deficiency Tags: D5471 D5471

Summary:

Summary Statement of Deficiencies D5471 CONTROL PROCEDURES CFR(s): 493.1256(e)(1)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e)(i) Check each batch (prepared in-house), lot number (commercially prepared) and shipment of reagents, disks, stains, antisera, (except those specifically referenced in 493.1261 (a)(3)) and identification systems (systems using two or more substrates or two or more reagents, or a combination) when prepared or opened for positive and negative reactivity, as well as graded reactivity, if applicable. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on lack of documentation and interview with staff, the laboratory failed to check 1 of 1 lot number of Chlorizol Black reagent prior to or concurrent with use. The laboratory performed approximately 10 to 20 potassium hydroxide preparations using Chlorizol Black reagent. Findings include: 1. The laboratory failed to document they checked Chlroizol Black reagent for lot number 8094 expiring 2020/04/04. 2. In an interview conducted on 08/16/2018 at approximately 10 :00 A.M., staff confirmed they had not recorded they checked each new lot number of reagents in use prior to performing patient tests. 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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