Kennesaw Pediatrics Pc

CLIA Laboratory Citation Details

2
Total Citations
7
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 11D1010647
Address 3745 Cherokee Street, Suite 401, Kennesaw, GA, 30144
City Kennesaw
State GA
Zip Code30144
Phone(770) 429-1005

Citation History (2 surveys)

Survey - September 28, 2021

Survey Type: Standard

Survey Event ID: U80I11

Deficiency Tags: D0000 D6053 D6054

Summary:

Summary Statement of Deficiencies D0000 A Clinical Laboratory Improvement Amendments (CLIA) recertification survey was completed on September 28, 2021. The laboratory was not in compliance with applicable CLIA requirements found at 42 CFR 493.1 through 42 CFR 493.1780. The following deficiencies were cited: D6053 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing at least semiannually during the first year the individual tests patient specimens. This STANDARD is not met as evidenced by: Based on review of testing personnel (TP) documents and staff interview , the technical consultant failed to perform semiannual competency on all testing personnel. Findings include: 1. Review of TP competency documents reveals the TC failed to perform semi-annual competency on staff #5 (CMS 209) in January 2021. 2. Interview with staff #2 (CMS 209) on 9/28/21 in the office area outside the lab at approximately 12:00 Noon, confirmed the lack of the aforementioned document. D6054 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing at least annually, after the first year. This STANDARD is not met as evidenced by: Based on review of testing personnel (TP) documents and staff interview , 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 2 -- technical consultant (TC) failed to perform annual competency on all testing personnel. Findings include: 1. Review of TP competency documents reveals the TC failed to perform annual competencies on staff #2 (CMS 209) and staff #7 (CMS 209) in 2020. 2. Interview with staff #2 (CMS 209) on 9/28/21 in the office area outside the lab at approximately 12:00 Noon, confirmed the lack of the aforementioned documents. -- 2 of 2 --

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Survey - April 10, 2019

Survey Type: Standard

Survey Event ID: 2H2U11

Deficiency Tags: D0000 D5417 D5807 D6054

Summary:

Summary Statement of Deficiencies D0000 A Clinical Laboratory Improvement Amendments (CLIA) recertification survey was completed on April 10, 2019. The laboratory was not in compliance with applicable CLIA requirements found at 42 CFR 493.1 through 42 CFR 493.1780. The following deficiencies were cited: 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 the laboratory tour and an interview with the laboratory lead tech (TP # 3 CMS 209), the laboratory failed to check its testing supply inventory properly for expiration dates before use. Findings include: 1. Laboratory tour revealed seventy (70%) percent of the Microcapilary blood collection tubes (200 ul Ram Scientific) for Bilirubin and C-Reactive Protein (CRP) expired in November 2018. 2. Secondly, thirty (30%) of Urine culture tubes (Uricult by Orion Diagnostics INC) had an expiration date of 03/18/2019. 3. An interview with the laboratory lead tech (TP # 3 CMS 209) at approximately 10:40 am on April 10, 2019 during the tour comfirmed the tubes were expired. D5807 TEST REPORT CFR(s): 493.1291(d) Pertinent "reference intervals" or "normal" values, as determined by the laboratory performing the tests, must be available to the authorized person who ordered the tests and, if applicable, the individual responsible for using the test results. 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 -- This STANDARD is not met as evidenced by: Based on postanalytic records review and an interview with the laboratory lead tech (TP # 3 CMS 209), the laboratory failed to have test reference ranges reflected on the final laboratory reports. Findings include: 1. Final patient CBC in-house reports did not have "reference ranges" reflected on the reports. 2. An interview with the laboratory lead tech (TP # 3 CMS 209) at approximately 02:30 pm on April 10, 2019 in the break room confirmed in-house patient final reports did not have reference ranges reflected on them. D6054 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing at least annually, after the first year. This STANDARD is not met as evidenced by: Based on Personnel competency records review and an interview with the laboratory's lead tech (TP # 3 CMS 209), the technical consultant (TC) failed to perform annual competencies on all Testing Personnel (TP) in 2018 and 2019 as required. Findings include: 1. 2018 and 2019 competency records review revealed the TC did not perform annual competencies on (TP #s 1 - 15 CMS 209). The competencies were instead performed by the laboratory's lead tech. 2. Annual competencies were not performed by the TC on the two physicians (TP #1 and #15 CMS 209) who performed PPM microscopy in 2018. 3. An interview with laboratory lead tech (TP # 3 CMS 209) on April 10, 2019 in the break room at approximately 02:40 p.m. confirmed annual competencies for the aforementioned testing personnel (TP) were not performed by the Technical Consultant. -- 2 of 2 --

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