Las Vegas Urology-Smoke Ranch

CLIA Laboratory Citation Details

3
Total Citations
26
Total Deficiencyies
11
Unique D-Tags
CMS Certification Number 29D0887993
Address 7500 Smoke Ranch Road Suit 200, Las Vegas, NV, 89128
City Las Vegas
State NV
Zip Code89128
Phone(702) 385-4342

Citation History (3 surveys)

Survey - March 22, 2023

Survey Type: Standard

Survey Event ID: 54ZX11

Deficiency Tags: D0000 D5215 D5413 D6032 D6091 D6111 D0000 D5215 D5413 D6032 D6091 D6111

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 22, 2023. 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 American Proficiency Institute (API) Microbiology Proficiency Testing (PT) records for test events one and three, and an interview with the technical supervisor, the laboratory failed to ensure that ungraded results were evaluated for accuracy. Findings include: 1. A review of the 2022 API PT microbiology test event one revealed that the laboratory failed to evaluate the ungraded results for the following Molecular Resistance Genes-Urine for specimen UTI-01: CTX-M Group 1, dfrA, ErmB, IMP, mecA, NDM, OXA-48, sul1, VIM. 2. A review of the 2022 API PT microbiology test event one revealed that the laboratory failed to evaluate the ungraded results for the following Molecular Resistance Genes- Urine for specimen UTI-02: mecA, mefA, OXA-48, qnrA, qnrB, qnrS, vanB. 3. A review of the 2022 API PT microbiology test event three revealed that the laboratory failed to evaluate the ungraded results for the Molecular Mycology-Urine for specimen UTI-05. The laboratory reported that Candida species was detected. 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 10 -- expected result stated to "See Data Summary." 4. The technical supervisor confirmed the findings during a telephone interview on March 22, 2023 at approximately 10:30 AM. The laboratory performs approximately 20,000 microbiology tests annually. D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on review of the temperature logs for March 1, 2023 through March 22, 2023 and an interview with the technical supervisor, the laboratory failed ensure that temperatures for freezer #1 were maintained within the acceptable range established by the laboratory. Findings include: 1. Review of the temperature logs for March 1, 2023, through March 22, 2023 revealed that laboratory Freezer #1, where PCR reagents and frozen specimens were stored, was above the acceptable range for eight of twenty-two days. No

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Survey - December 10, 2021

Survey Type: Special

Survey Event ID: 29MG11

Deficiency Tags: D0000 D2016 D2028 D6076 D6089 D0000 D2016 D2028 D6076 D6089

Summary:

Summary Statement of Deficiencies D0000 This Statement of Deficiencies was generated as a result of the CLIA proficiency testing desk review, conducted off-site for your laboratory on 12/10/2021. 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. D2016 SUCCESSFUL PARTICIPATION CFR(s): 493.803(a)(b)(c) (a) Each laboratory performing nonwaived testing must successfully participate in a proficiency testing program approved by CMS, if applicable, as described in subpart I of this part for each specialty, subspecialty, and analyte or test in which the laboratory is certified under CLIA. (b) Except as specified in paragraph (c) of this section, if a laboratory fails to participate successfully in proficiency testing for a given specialty, subspecialty, analyte or test, as defined in this section, or fails to take remedial action when an individual fails gynecologic cytology, CMS imposes sanctions, as specified in subpart R of this part. (c) If a laboratory fails to perform successfully in a CMS- approved proficiency testing program, for the initial unsuccessful performance, CMS may direct the laboratory to undertake training of its personnel or to obtain technical assistance, or both, rather than imposing alternative or principle sanctions except when one or more of the following conditions exists: (1) There is immediate jeopardy to patient health and safety. (2) The laboratory fails to provide CMS or a CMS agent with satisfactory evidence that it has taken steps to correct the problem identified by the unsuccessful proficiency testing performance. (3) The laboratory has a poor compliance history. This CONDITION is not met as evidenced by: Based on desk review of federal database CASPER Reports 153D and 155D, American Proficiency Institute (API) proficiency testing (PT) evaluation forms, and 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 -- interview with the Director of Laboratory Compliance on 12/10/2021, the laboratory did not successfully participate in a proficiency testing program. The laboratory's failure to achieve an overall satisfactory proficiency testing event performance for two consecutive testing events for the second and third testing events of 2021 with a score of 63% and 70%, respectively, resulted in unsuccessful proficiency testing performance for the subspecialty of bacteriology. Findings include: The laboratory failed to maintain successful participation with the API PT program shown by the unsuccessful performance for the subspecialty of bacteriology in the second and third testing events of 2021. Refer to D2028. D2028 BACTERIOLOGY CFR(s): 493.823(e) Failure to achieve an overall testing event score of satisfactory performance for two consecutive testing events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on desk review of federal database CASPER Reports 153D and 155D, American Proficiency Institute (API) proficiency testing (PT) evaluation forms, and interview with the Director of Laboratory Compliance on 12/10/2021, the laboratory did not successfully participate in a proficiency testing program. The laboratory's failure to achieve an overall satisfactory proficiency testing event performance for two consecutive testing events for the second and third testing events of 2021 with a score of 63% and 70%, respectively, resulted in unsuccessful proficiency testing performance for the subspecialty of bacteriology. Findings include: 1. The laboratory failed to maintain successful participation with the API PT program shown by the unsuccessful performance for the subspecialty of bacteriology in the second and third testing events of 2021 with scores of 63% and 70%, respectively. 2. CASPER Reports 153D and 155D and the API PT Performance Evaluation reported scores of 63% and 70% for bacteriology for the second and third testing events, respectively, of 2021. 3. The Director of Laboratory Compliance interviewed on 12/10/2021 at approximately 8:30 AM confirmed the findings. D6076 LABORATORY DIRECTOR CFR(s): 493.1441 The laboratory must have a director who meets the qualification requirements of 493. 1443 of this subpart and provides overall management and direction in accordance with 493.1445 of this subpart. This CONDITION is not met as evidenced by: Based on desk review of federal database CASPER Reports 153D and 155D, American Proficiency Institute (API) proficiency testing (PT) evaluation forms, and interview with the Director of Laboratory Compliance on 12/10/2021, the Condition: Laboratories Performing High Complexity Testing; Laboratory Director was not met. The labortory director, high complxity testing, failed to provide overall management and direction in accordance with CFR 493.1445 of this subpart. Findings include: The laboratory director failed to ensure tht the laboratory successfully participated in a PT -- 2 of 3 -- program, approved by CMS; as descirbed in subpart 1 of this part for each specialty, subspeicalty, and analyte or test in which the laboratory is certifed under CLIA. Refer to D6089. D6089 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(i) The laboratory director must ensure the proficiency testing samples are tested as required under subpart H of this part. This STANDARD is not met as evidenced by: Based on desk review of federal database CASPER Reports 153D and 155D, American Proficiency Institute (API) proficiency testing (PT) evaluation forms, and interview with the Director of Laboratory Compliance on 12/10/2021, the laboratory did not successfully participate in a proficiency testing program. The laboratory director failed to ensure that proficiency testing samples were tested as required. Findings include: 1. The laboratory failed to achieve an overall satisfactory proficiency testing event performance for two consecutive testing events for the second and third testing event of 2021 with score of 63 % and 70%, respectively, in the subspecialty of bacteriology which resulted in unsuccessful proficiency testing performance. 2. CASPER Reports 153D and 155D and API PT Performance Evaluations reported scores of 63% and 70% for the second and third testing events, respectively, of 2021 in bacteriology. 3. In a telephone interview on 12/10/2021 at approximately 8:30 AM, the Director of Laboratory Compliance confirmed the laboratory's unsuccessful performance in two consecutive bacteriology testing events for 2021. -- 3 of 3 --

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Survey - October 11, 2021

Survey Type: Standard

Survey Event ID: 79HW11

Deficiency Tags: D0000 D5217 D0000 D5217

Summary:

Summary Statement of Deficiencies D0000 This Statement of Deficiencies was created as a result of an on-site initial CLIA certification survey conducted at your facility October 11, 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. 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 Event 2 American Proficiency Institute (API) Microbiology proficiency testing (PT) results, a review of the director approved laboratory procedure entitled, "Proficiency Testing," a review of the results of a comparison study with an outside laboratory evaluated on October 7, 2021, and an interview with the laboratory Technical Supervisor, the laboratory failed to establish a step-by-step policy and procedure for the performance and evaluation of the split sample analysis performed to verify the accuracy of the polymerase chain reaction testing for the urine pathogen identification. Findings include: 1. A review of the API 2021 Microbiology PT Event 2 test results revealed that the laboratory received a score of 63% for the urine organism identification. 2. The laboratory performed a study of ten specimens on September 28, 2021, and sent the ten specimens to another laboratory, which analyzed the specimens on September 30, 2021. The results of the split sample analysis to determine the accuracy of the urine identification test by PCR were evaluated on October 7, 2021. 3. The director approved policy entitled, "Proficiency Testing," did not include step by step instructions on the performance of a split sample analysis that specified the number of specimens to be tested, and 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 -- criteria for acceptability for the results of the evaluation in order to verify the accuracy of the test. 4. The technical supervisor confirmed the findings during an interview conducted on October 11, 2021 at approximately 10:30 AM. The laboratory performs approximately 2500 microbiology tests annually. -- 2 of 2 --

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