Grover C Dils Medical Center

CLIA Laboratory Citation Details

4
Total Citations
26
Total Deficiencyies
10
Unique D-Tags
CMS Certification Number 29D0663011
Address 700 N Spring Street, Caliente, NV, 89008
City Caliente
State NV
Zip Code89008
Phone(775) 726-8001

Citation History (4 surveys)

Survey - August 12, 2024

Survey Type: Standard

Survey Event ID: XTJE11

Deficiency Tags: D0000 D5411 D5217 D5411 D5217 D5215

Summary:

Summary Statement of Deficiencies D0000 This Statement of Deficiencies was created as a result of an on-site CLIA recertification survey conducted at your facility on August 12, 2024. The findings and conclusions of any investigation by the Division of Public and Behavioral Health shall not be construed as prohibiting any criminal or civil investigations, actions or other claims for relief that may be available to any party under applicable federal, state, or local laws. D5215 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(b)(2) The laboratory must verify the accuracy of any analyte, specialty or subspecialty assigned a proficiency testing score that does not reflect laboratory test performance (that is, when the proficiency testing program does not obtain the agreement required for scoring as specified in subpart I of this part, or the laboratory receives a zero score for nonparticipation, or late return or results). This STANDARD is not met as evidenced by: Based on a review of the 2022 and 2023 American Proficiency Institute (API) Proficiency Testing (PT) records for Hematology and Coagulation, and an interview with general supervisor number one listed on the CMS-209 form, the laboratory failed to ensure that the ungraded educational challenges for the Blood Cell Identification and the ungraded vaginal wet preparation results were reviewed, and documented. Findings include: 1. A review of the 2022 API PT Hematology/Coagulation test event two report revealed that the laboratory failed to review and document the ungraded educational blood identification, and platelet estimate for sample DIF-02. The reported result for Neutrophil, segmented or band was 1%. The expected result was 41-71%. The reported result for the Platelet Estimate was increased. The expected result was Adequate/Normal. 2. A review of the 2022 API PT Hematology /Coagulation test event two report revealed that the laboratory failed to review and document the ungraded Vaginal Wet Preparation result for sample VA-02. 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 -- reported result was Trichomonas seen. The expected result stated to review the data summary. There was no documentation of a review of the data summary. 3. A review of the 2023 API PT Hematology/Coagulation test event one report revealed that the laboratory failed to review and document the ungraded educational blood identification for sample DIF-01. The reported result for Immature Cell was 29%. The expected result was 57-100%. The reported result for Lymphocyte was 49%. The expected result was 0-16%. The reported result for Unclassifed Cell was 3%. The expected result was 0-2%. 4. A review of the 2023 API PT Hematology/Coagulation test event one report revealed that the laboratory failed to review and document the ungraded educational blood identification for sample DIF-01. The reported result for Immature Cell was 29%. The expected result was 57-100%. The reported result for Lymphocyte was 49%. The expected result was 0-16%. The reported result for Unclassifed Cell was 3%. The expected result was 0-2%. 5. A review of the 2023 API PT Hematology/Coagulation test event two report revealed that the laboratory failed to review and document the ungraded platelet estimate for sample DIF-02. The reported result for the platelet estimate was increased. The expected result was Adequate/Normal. 6. The findings were confirmed during an interview with general supervisor number one listed on the CMS-209 form conducted on August 12, 2024 at approximately 4:30 PM. The laboratory performs approximately 4503 hematology tests and 321 microbiology tests 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. This STANDARD is not met as evidenced by: Based on a review of the 2022 American Proficiency Institute (API) Proficiency Testing (PT) records for miscellaneous chemistry, and an interview with general supervisor number one listed on the CMS-209 form, the laboratory failed to verify the accuracy urine benzodiazepine and methadone twice annually during 2022. Findings include: 1. A review of the 2022 API PT records for miscellaneous revealed that the laboratory obtained a score of 67% for Methadone during the first test event of 2022. The laboratory obtained a score of 67% for Benzodiazepines during the second test event of 2022. 2. The findings were confirmed during an interview with general supervisor number one listed on the CMS-209 form conducted on August 12, 2024 at approximately 4:30 PM. The laboratory performs approximately 5835 chemistry tests annually. D5411 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(a) Test systems must be selected by the laboratory. The testing must be performed following the manufacturer's instructions and in a manner that provides test results within the laboratory's stated performance specifications for each test system as determined under 493.1253. This STANDARD is not met as evidenced by: Based on a review of the manufacturer's package insert, observation of the Sysmex CA-600 programming for the INR calculation, and and interview with General -- 2 of 3 -- Supervisor numbers one and two on the CMS-209 form, the laboratory failed to ensure that the ISI was updated in the instrument when the current lot number of Dade Innovin reagent was placed in use for the Prothrombin Time (Protime) test. Findings include: 1. A review of the Dade Innovin package insert revealed that the ISI value for lot number 564657 for use on the Sysmex CA-600 coagulation instrument was 1.08. 2. Observation of the current programming in the Sysmex CA-600 analyzer revealed that the ISI in the instrument was 1.04. 3. The findings were confirmed during an interview with the General Supervisor numbers one and two conducted on August 12, 2024 at approximately 4:30 PM. The laboratory performs approximately 4503 hematology tests annually. -- 3 of 3 --

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Survey - October 17, 2022

Survey Type: Standard

Survey Event ID: 2FOP11

Deficiency Tags: D0000 D5217 D5439 D0000 D5217 D5439

Summary:

Summary Statement of Deficiencies D0000 This Statement of Deficiencies was created as a result of an on-site CLIA recertification survey conducted at your facility on October 17, 2022. The findings and conclusions of any investigation by the Division of Public and Behavioral Health shall not be construed as prohibiting any criminal or civil investigations, actions or other claims for relief that may be available to any party under applicable federal, state, or local laws. 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 a review of the 2021 American Proficiency Institute (API) Proficiency Testing (PT) Immunology/Immunohematology results, a review of the director approved policy and procedure for Proficiency Testing, and an interview with the laboratory director and the laboratory supervisor, the laboratory failed to verify the accuracy of the SARS-CoV-2 antibody testing at least twice annually during 2021. Findings include: 1. The laboratory failed to obtain a passing score for the 2021 API Immunology/Immunohematology Proficiency Testing Events number 1 and 3 for the SARS-CoV-2 Antibody test. The laboratory received a score of 50% for both Event 1 and for Event 3. 2. The director approved procedure entitled, "Proficiency Testing" failed to include a provision for performing alternative proficiency testing in the event that the laboratory fails to obtain a passing score for two consecutive events, or two out of three events to verify the accuracy of analytes not listed in subpart I of 42 CFR 493, as required. 3. An interview with the laboratory director and the laboratory supervisor conducted on October 17, 2022 at approximately 12:00 PM confirmed the findings. The laboratory performs approximately 118 general immunology tests 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 2 -- 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 records for calibration verification for the sodium, potassium and chloride analytes on the Siemens Dimension EXL chemistry analyzer, a review of the director approved policy, and an interview with the laboratory supervisor, the laboratory testing personnel, and the laboratory director, and email correspondence received from the laboratory, the laboratory failed to ensure that the calibration verification was performed every six months in 2021. Findings include: 1. A review of the calibration verification records for the sodium, potassium, and chloride revealed that the laboratory failed to perform calibration verification in December, 2021. The verification was performed on June 12, 2021, and May 23, 2022. 2. The director approved policy and procedure stated, " Recalibration or calibration verification and AMR validation, must be performed at least once every 6 months as specified under CLIA-88 regulations at 42CFR493.1255(b)(3)." (sic) 2. An interview with the laboratory director, the laboratory supervisor, and the laboratory testing personnel confirmed that the records could not be located at approximately 4: 45 PM on October 17, 2022. 3. An email received from the laboratory on October 18, 2022 at approximately 4:57 PM confirmed that the calibration verification was not performed in December, 2021. The laboratory performs approximately 4638 Chemistry tests annually. -- 2 of 2 --

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Survey - March 1, 2021

Survey Type: Standard

Survey Event ID: 49XK11

Deficiency Tags: D0000 D5781 D6018 D0000 D5781 D6018

Summary:

Summary Statement of Deficiencies D0000 This Statement of Deficiencies was created as a result of an on-site CLIA recertification survey conducted at your facility on March 1, 2021. The findings and conclusions of any investigation by the Division of Public and Behavioral Health shall not be construed as prohibiting any criminal or civil investigations, actions or other claims for relief that may be available to any party under applicable federal, state, or local laws. D5781

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Survey - July 9, 2018

Survey Type: Standard

Survey Event ID: XNR611

Deficiency Tags: D0000 D5793 D5793 D6013 D0000 D6013 D6106 D6106

Summary:

Summary Statement of Deficiencies D0000 This Statement of Deficiencies was created as a result of an on-site CLIA recertification survey conducted at your facility on July 9, 2018. The findings and conclusions of any investigation by the Division of Public and Behavioral Health shall not be construed as prohibiting any criminal or civil investigations, actions or other claims for relief that may be available to any party under applicable federal, state, or local laws. D5793 ANALYTIC SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1289(b)(c) (b) The analytic systems quality assessment must include a review of the effectiveness of

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