Jennifer Caudill Md Pllc

CLIA Laboratory Citation Details

3
Total Citations
9
Total Deficiencyies
4
Unique D-Tags
CMS Certification Number 23D0687945
Address 5885 S Main St Suite 1, Clarkston, MI, 48346
City Clarkston
State MI
Zip Code48346
Phone248 623-9700
Lab DirectorJENNIFER CAUDILL

Citation History (3 surveys)

Survey - October 9, 2024

Survey Type: Standard

Survey Event ID: JSCK11

Deficiency Tags: D5209 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 record review and interview with the Office Manager, the laboratory failed to follow established competency assessment policies for testing personnel (TP) for 2 (TP1, TP2) of 2 testing personnel. Findings include: 1. A record review of the laboratory Personnel Competency Assessments revealed: a. An annual competency assessment was not conducted for TP1 (2024, 2023 and 2022). b. An initial competency assessment was not conducted for TP2, whose employment began in June 2024. 2. A review of laboratory records revealed that TP2 conducted and reported 154 tests from 6/14/2024 to 10/07/2024. 3. A review of the Laboratory's "Personnel Competency Policy / Procedure," in section, "Competency", states "All testing personnel must be reviewed for their ability to perform patient testing correctly and accuracy. Laboratory compliance requires testing personnel to be reviewed prior to testing patient specimens to ensure that all personnel have the appropriate train and experience for the type of testing being performed. Laboratory compliance requires training/competency to be completed initially, 6-months after the initial start date and annually thereafter." 4. An interview conducted on 10/09/2024 at 2:45 pm with the Office Manager confirmed that records were not present. 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 - October 19, 2022

Survey Type: Standard

Survey Event ID: XJ8T11

Deficiency Tags: D5473 D5473

Summary:

Summary Statement of Deficiencies D5473 CONTROL PROCEDURES CFR(s): 493.1256(e)(2)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e) (2) Each day of use (unless otherwise specified in this subpart), test staining materials for intended reactivity to ensure predictable staining characteristics. Control materials for both positive and negative reactivity must be included, as appropriate. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on record review and interview with the Office Manager, the laboratory failed to ensure hematoxylin and eosin staining quality for biopsy microscopic tissue examinations each day of testing for 5 of 5 patients tested from January 2022 to October 2022. Findings include: 1. A review of the laboratory's "Pathology Log Sheet" for 2022 revealed the laboratory had performed biopsy microscopic tissue examinations with hematoxylin and eosin staining materials for 5 patients between January and October. 2. A review of the laboratory's "Guidelines for Slide Prep Only in Pathology Book" policy revealed a lack of process to perform and record hematoxylin and eosin staining quality. 3. The surveyor requested documentation of stain quality for the patient testing listed above on 10/19/22 at 12:15 pm and it was not made available. 4. An interview on 10/19/22 at 12:35 pm the Office Manager revealed the laboratory did not have documented stain quality for biopsies tested from January to October 2022. 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 - April 28, 2021

Survey Type: Standard

Survey Event ID: O9S311

Deficiency Tags: D5217 D5209 D5417 D5217 D5417

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 record review and interview with the Office Staff, the laboratory failed to follow procedures to assess testing personnel competency for 1 (Testing Personnel #2) of 2 testing personnel listed on the CMS-209 form. Findings include: 1. A record review of the laboratory's records revealed a lack of documentation of a competency assessment for Testing Personnel #2 performing histopathology testing in 2020. 2. A review of the laboratory's "Quality Assessment Policy" revealed a section stating, "The laboratory must establish and follow written policies and procedures for an on- going mechanism to monitor, assess and when indicated, correct problems identified in all four quality systems." Under "General Laboratory Systems" lists, "Personnel Competency Assessments." 3. An interview on 4/28/21 at 9:30 am with the Office Staff confirmed the laboratory did not have a competency assessment for Testing Personnel #2 performed in 2020. 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 record review and interview with the Office Staff, the laboratory failed to 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 -- verify the accuracy of its histopathology testing at least twice annually in 2019. Findings include: 1. A review of the laboratory's "Slide Review Log" revealed a lack of a second verification of accuracy testing event in 2019. 2. A review of the laboratory's "Policy for Quality Assessment of Analytic Systems" revealed a section stating, "Twice a year an analytic quality assessment will be performed by choosing at least 1 mohs slide and chart to be reviewed by a physician to confirm the correct diagnosis." 3. An interview on 4/28/21 at 9:30 am with the Office Staff confirmed the laboratory did not have documentation available for the second verification of accuracy testing event in 2019. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. This STANDARD is not met as evidenced by: . Based on observation and interview with the Office Staff, the laboratory failed to ensure histopathology inks were not used beyond the expiration date for 7 months (September 2020 to April 2021) since the inks had expired. Findings include: 1. The surveyor conducted a virtual tour of the laboratory on 4/26/21 at 9:37 am. During the tour, it was discovered the inks used in histopathology testing had an expiration date of 9/6/2020. 2. An interview on 4/26/21 at 9:45 am with the Office Staff confirmed the inks used in histopathology testing were expired. -- 2 of 2 --

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