Jacksonville Beach Pediatric Care Center

CLIA Laboratory Citation Details

2
Total Citations
6
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 10D2012469
Address 8990 Rg Skinner Pkwy, Jacksonville, FL, 32256
City Jacksonville
State FL
Zip Code32256
Phone904 519-6555
Lab DirectorNORBERTO BENITEZ

Citation History (2 surveys)

Survey - April 21, 2022

Survey Type: Standard

Survey Event ID: 6FOL11

Deficiency Tags: D5439 D0000

Summary:

Summary Statement of Deficiencies D0000 A recertification survey was conducted on April 21, 2022 . Jacksonville Beach Pediatric Care Center was found NOT in compliance with 42 CFR 493, Requirements for Clinical Laboratories. . 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 record review and staff interview, the facility failed to perform the calibration verification at least once every 6 months for the Sysmex XP-300 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 -- hematology analyzer. Findings include: The record review on 4/21/22 of the calibration documentation for the Sysmex XP-300 hematology analyzer showed calibration was performed 10/21/20 and 10/15/21. The interview with Testing Person A on 4/21/22 at 8:45am confirmed calibration had not been performed every 6 months. -- 2 of 2 --

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Survey - February 27, 2020

Survey Type: Standard

Survey Event ID: R8Z711

Deficiency Tags: D0000 D2015 D2007 D5421

Summary:

Summary Statement of Deficiencies D0000 A recertification survey was conducted on February 27, 2020 . Jacksonville Beach Pediatric Care Center was found NOT in compliance with 42 CFR 493, Requirements for Clinical Laboratories. . 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 record review and staff interview, the laboratory failed to rotate proficiency testing to include all testing personnel who perform patient testing for all testing events in 2019. The findings include: Review of the Testing Personnel sheet revealed that 9 people performed patient testing (Testing Person #A, B, C, D, E, F, G, H, and I). Review of American Proficiency Institute (API) proficiency testing attestation statements showed that only Testing Person #E performed proficiency testing for the 1st, 2nd, and 3rd events of 2019. During an interview on 2/27/20 with the Technical Consultant #1/Testing Person #E, it was confirmed that no other Testing Persons had performed proficiency testing and that it was only being performed by "management". 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 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 -- 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 record review and interview with laboratory personnel, the laboratory did not have documentation of signed attestations for two of two years reviewed (2018- 2019). The findings include: Review of all proficiency records for 2018-2019 showed that the Laboratory Director or Designee had not signed the attestations. During an interview with Technical Consultant #1, it was confirmed the Laboratory Director had not signed the attestations for the last two years. D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE CFR(s): 493.1253(b)(1) Each laboratory that introduces an unmodified, FDA-cleared or approved test system must do the following before reporting patient test results: (1)(i) Demonstrate that it can obtain performance specifications comparable to those established by the manufacturer for the following performance characteristics: (1)(i)(A) Accuracy. (1)(i) (B) Precision. (1)(i)(C) Reportable range of test results for the test system. (1)(ii) Verify that the manufacturer's reference intervals (normal values) are appropriate for the laboratory's patient population. This STANDARD is not met as evidenced by: Based on record review and interview, the laboratory failed to complete verification for Complete Blood Count testing on the Sysmex XP-300 hematology analyzer. The findings include: Review of the laboratory's records for performance verification for Complete Blood Counts (CBCs) on the new Sysmex XP-300 analyzer showed that the laboratory had not completed the correlation studies and reference range verification for CBCs. During an interview on 2/27/20 at 10:41 AM, Technical Consultant #1 confirmed that the laboratory had not performed correlation studies or reference range verification because they thought the manufacturer had performed all necessary validation procedures. -- 2 of 2 --

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