Illinois Dermatology Institute Llc

CLIA Laboratory Citation Details

4
Total Citations
10
Total Deficiencyies
8
Unique D-Tags
CMS Certification Number 14D1071032
Address 1550 N Northwest Hwy, Ste 300, Park Ridge, IL, 60068
City Park Ridge
State IL
Zip Code60068
Phone(847) 298-1831

Citation History (4 surveys)

Survey - February 14, 2025

Survey Type: Standard

Survey Event ID: D2NS11

Deficiency Tags: D5209

Summary:

Summary Statement of Deficiencies D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES CFR(s): 493.1235 As specified in the personnel requirements in subpart M, the laboratory must establish and follow written policies and procedures to assess employee and, if applicable, consultant competency. This STANDARD is not met as evidenced by: Based on review of the CMS-209 (Laboratory Personnel Form), laboratory policies and procedures, lack of documentation, and interview with the laboratory representative, the laboratory failed to have a formal competency assessment policy /procedure in place to assess employee competency for five of five testing personnel (TP) performing grossing in the subspecialty of histopathology. Findings include: 1. Review of the CMS-209 (Laboratory Personnel Form) revealed five TP performing grossing in the subspecialty of histopathology. 2. Review of the laboratory policies and procedures revealed the lack of a formal competency assessment policy/procedure in place for five of five TP (TP #3-7) performing high complexity grossing. 3. Interview with the laboratory representative on 02/14/2025, at 10:26 am, confirmed the laboratory failed to have a formal competency policy/procedure in place to assess employee competency for five of five TP performing grossing in the subspecialty of histopathology. 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 - July 21, 2021

Survey Type: Standard

Survey Event ID: MB1H11

Deficiency Tags: D5200 D5217 D6051

Summary:

Summary Statement of Deficiencies D5200 GENERAL LABORATORY SYSTEMS CFR(s): 493.1230 Each laboratory that performs nonwaived testing must meet the applicable general laboratory systems requirements in 493.1231 through 493.1236, unless HHS approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing. The laboratory must monitor and evaluate the overall quality of the general laboratory systems and correct identified problems specified in 493.1239 for each specialty and subspecialty of testing performed. This CONDITION is not met as evidenced by: Based on records review,

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Survey - June 28, 2019

Survey Type: Complaint

Survey Event ID: E50D11

Deficiency Tags: D6096

Summary:

Summary Statement of Deficiencies D6096 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(7) The laboratory director must ensure that all necessary remedial actions are taken and documented whenever significant deviations from the laboratory's established performance characteristics are identified. This STANDARD is not met as evidenced by: Based on record review, lack of documentation, and an interview with the laboratory director (LD), the LD failed to take and document all necessary remedial actions whenever significant deviations from the laboratory's established performance characteristics are identified in the specialty of Histopathology. Findings include: 1. The laboratory's Mohs' procedures manual and case quality assurance (QA) results were reviewed. 2. The laboratory's Mohs QA procedure states the following: "One case in 20 will be reviewed by a qualified Board Certified Dermatopathologist. Each case will be reviewed for accuracy and completeness." 3. Review of 9 cases revealed the following: * The Dermatopathologist did not agree with the presence of Tumor for 7 out of 9 cases reviewed on 02/05/2019. * The LD failed to take and document any actions needed in response to the result discrepancies created from the Dermatopathologist's interpretations. * The LD failed to access and correct, if applicable, the possible patient affect for the cases where disagreements of result interpretations were made for 7 out of 7 patients. 4. The manual failed to include a policy and procedure for investigating and resolving the QA review result discrepancies. 5. On 03/19/2019 at 1:00 PM, the LD confirmed the above 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 - February 7, 2019

Survey Type: Standard

Survey Event ID: Q2L711

Deficiency Tags: D2007 D5209 D5217 D6168 D6171

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 the surveyor's review of the laboratory's records, manual, and an interview with the testing personnel (TP); the laboratory failed to test proficiency testing (PT) samples with the personnel who routinely perform the test in the laboratory, affecting 3 out 5 TP. Findings: 1. The CMS 209 lists 3 licensed practitioners and 2 licensed physicians performing Potassium Oxide (KOH) testing in the laboratory 2. For the years of 2017 through 2018, the PT records and patients' test logs revealed the following: a). The laboratory participated in 6 out of 6 PT events for KOH testing during this period. b). The PT signature statements attests that 2 TP of the 5 TP; ("TP- AA" listed on line 1 and "TP-7Z" listed on line 4); participated in the 6 PT events. c). The patients' test log show that all 5 TP were performing KOH testing during this period. d). No other documentation was provided as evidence that the remaining 3 TP (listed on lines 5 thru 7); had participated in any PT event since 2016. 3. On a Recertification survey conducted on 02/07/2019 at 12:30 PM, the TP confirmed the above findings. D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES CFR(s): 493.1235 As specified in the personnel requirements in subpart M, the laboratory must establish and follow written policies and procedures to assess employee and, if applicable, consultant competency. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 4 -- This STANDARD is not met as evidenced by: Based on the surveyor's review of the Laboratory Personnel Report (CMS 209), the laboratory's manuals, records, and an interview with the testing personnel (TP); the laboratory failed to establish written policies and procedures to assess employees performing Potassium Oxide (KOH) testing, affecting 5 out of 5 testing personnel (TP). Findings: 1. The CMS 209 lists 3 licensed practitioners and 2 licensed physicians performing KOH testing in the laboratory. 2. The personnel files revealed that 5 out of 5 TP had not received competencies for the years of 2017 thru 2018, but were performing patient testing during this period. 3. The laboratory's manual does not have an established competency policy and step-by-step procedure for TP performing KOH testing. 4. No documentation was provided as proof that the TP's competency had been assessed with a protocol that include these required criteria: a) Direct observations of routine patient test performance, including patient preparation, if applicable, specimen handling, processing and testing; b). Monitoring the recording and reporting of test results (for example, recording patients and their results in the labs' test log and/or EMR system); c). If applicable, review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records; d). Direct observation of performance of instrument maintenance and function checks (i.e. microscope maintenance, etc.); e). Assessment of test performance through testing previously analyzed specimens, internal blind testing samples or external proficiency testing samples; and f). Assessment of problem solving skills; and g). Evaluating and documenting the performance of individuals responsible for moderately complex testing at least semiannually during the first year the individual tests patient specimens. Thereafter, evaluations must be performed at least annually. 5. On a Recertification survey conducted on 02/07/2019 at 12:30 PM, the TP confirmed the above findings. 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 the surveyor's review of the laboratory's proficiency testing (PT) reports, records, manual, and an interview with the testing personnel (TP); the laboratory failed to verify the accuracy of the Potassium Hydroxide (KOH) preparations it performs at least twice annually, affecting 50 patients' tests. Findings: 1. The laboratory participates in the American Proficiency Institute (API)-PT program for its KOH testing to fulfill the twice annual accuracy verification requirement for the procedure. 2. The scores received from API-PT for KOH testing are as follows: a). Event #1 of 2017, the KOH score received is '50%'; and b). Event #3 of 2017, the KOH score received is '0%'; 3. No documentation was provided as evidence that the laboratory chose another method to verify the accuracy of its KOH testing during the PT failure period. 4. The laboratory was performing KOH testing during the period when the accuracy of the KOH test had not been verified. 5. No documentation was presented as evidence that the laboratory evaluated or investigated the 2 PT failed events, and assessed if patients tested during this period were affected. 6. On a Recertification survey conducted on 02/07/2019 at 12:00 PM, the TP confirmed the above findings. -- 2 of 4 -- D6168 TESTING PERSONNEL CFR(s): 493.1487 The laboratory has a sufficient number of individuals who meet the qualification requirements of 493.1489 of this subpart to perform the functions specified in 493. 1495 of this subpart for the volume and complexity of testing performed. This CONDITION is not met as evidenced by: Based on the surveyor's review of the Laboratory Personnel Report (CMS-209), employee files, and an interview with the testing personnel (TP), the laboratory failed to employ individuals who meet the qualification requirements of 493.1489 for high complexity testing. Finding: 1. The laboratory failed to ensure laboratory personnel meet the qualification requirements for performing highly complex testing in the specialty of Histopathology. See D6171. D6171 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1489(b) (b) Meet one of the following requirements: (b)(1) Be a doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which the laboratory is located or have earned a doctoral, master's or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution; (b)(2)(i) Have earned an associate degree in a laboratory science, or medical laboratory technology from an accredited institution or-- (b)(2)(ii) Have education and training equivalent to that specified in paragraph (b)(2)(i) of this section that includes-- (b)(2)(ii)(A) At least 60 semester hours, or equivalent, from an accredited institution that, at a minimum, include either-- (b)(2)(ii)(A)(1) 24 semester hours of medical laboratory technology courses; or (b)(2)(ii)(A)(2) 24 semester hours of science courses that include-- (b)(2) (ii)(A)(2)(i) Six semester hours of chemistry; (b)(2)(ii)(A)(2)(ii) Six semester hours of biology; and (b)(2)(ii)(A)(2)(iii) Twelve semester hours of chemistry, biology, or medical laboratory technology in any combination; and (b)(2)(ii)(B) Have laboratory training that includes either of the following: (b)(2)(ii)(B)(1) Completion of a clinical laboratory training program approved or accredited by the ABHES, the CAHEA, or other organization approved by HHS. (This training may be included in the 60 semester hours listed in paragraph (b)(2)(ii)(A) of this section.) (b)(2)(ii)(B)(2) At least 3 months documented laboratory training in each specialty in which the individual performs high complexity testing. (b)(3) Have previously qualified or could have qualified as a technologist under 493.1491 on or before February 28, 1992; (b) (4) On or before April 24, 1995 be a high school graduate or equivalent and have either-- (b)(4)(i) Graduated from a medical laboratory or clinical laboratory training program approved or accredited by ABHES, CAHEA, or other organization approved by HHS; or (b)(4)(ii) Successfully completed an official U.S. military medical laboratory procedures training course of at least 50 weeks duration and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Laboratory Technician); (b)(5)(i) Until September 1, 1997-- (b)(5)(i)(A) Have earned a high school diploma or equivalent; and (b)(5)(i)(B) Have documentation of training appropriate for the testing performed before analyzing patient specimens. Such training must ensure that the individual has-- (b)(5)(i)(B)(1) The skills required for proper specimen collection, including patient preparation, if applicable, labeling, handling, preservation or fixation, processing or preparation, transportation and storage of specimens; (b)(5)(i)(B)(2) The skills required for implementing all standard -- 3 of 4 -- laboratory procedures; (b)(5)(i)(B)(3) The skills required for performing each test method and for proper instrument use; (b)(5)(i)(B)(4) The skills required for performing preventive maintenance, troubleshooting, and calibration procedures related to each test performed; (b)(5)(i)(B)(5) A working knowledge of reagent stability and storage; (b)(5)(i)(B)(6) The skills required to implement the quality control policies and procedures of the laboratory; (b)(5)(i)(B)(7) An awareness of the factors that influence test results; and (b)(5)(i)(B)(8) The skills required to assess and verify the validity of patient test results through the evaluation of quality control values before reporting patient test results; and (b)(5)(i)(B)(8)(ii) As of September 1, 1997, be qualified under 493.1489(b)(1), (b)(2), or (b)(4), except for those individuals qualified under paragraph (b)(5)(i) of this section who were performing high complexity testing on or before April 24, 1995; (b)(6) For blood gas analysis-- (b)(6) (i) Be qualified under 493.1489(b)(1), (b)(2), (b)(3), (b)(4), or (b)(5); (b)(6)(ii) Have earned a bachelor's degree in respiratory therapy or cardiovascular technology from an accredited institution; or (b)(6)(iii) Have earned an associate degree related to pulmonary function from an accredited institution; or (b)(7) For histopathology, meet the qualifications of 493.1449 (b) or (l) to perform tissue examinations. This STANDARD is not met as evidenced by: Based on the surveyor's review of the Laboratory Personnel Report (CMS-209), employee files, and an interview with the testing personnel (TP); the laboratory failed to ensure laboratory employees meet the qualification requirements for performing highly complex testing in the specialty of Histopathology. Findings: 1. The CMS 209 list 1 TP performing tissue grossing and processing for Mohs procedures (a high complexity test and procedure) in the laboratory. 2. The employee file of TP 'PK3', listed on line 3, included a Diploma from Everest College for Medical Assisting and a certificate of histotechnician training from the American Society for Mohs Surgery (ASMS) dated 11/11/2018. 3. No documentation (e.g., transcript) was provided to show that the education requirement) as defined 493.1489(b) (1) - (7) for high complexity TP was meet by TP-PK3. 4. On a Recertification survey conducted on 02 /07/2019 at 12:00 PM, the TP confirmed the above findings. -- 4 of 4 --

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