Livingston Healthcare

CLIA Laboratory Citation Details

4
Total Citations
21
Total Deficiencyies
11
Unique D-Tags
CMS Certification Number 27D0665300
Address 320 Alpenglow Lane, Livingston, MT, 59047
City Livingston
State MT
Zip Code59047
Phone(406) 222-3541

Citation History (4 surveys)

Survey - October 2, 2024

Survey Type: Standard

Survey Event ID: CIJ811

Deficiency Tags: D5553

Summary:

Summary Statement of Deficiencies D5553 IMMUNOHEMATOLOGY CFR(s): 493.1271(b)(f) (b) Immunohematological testing and distribution of blood and blood products. Blood and blood product testing and distribution must comply with 21 CFR 606.100(b)(12); 606.160(b)(3)(ii) and (b)(3)(v); 610.40; 640.5(a), (b), (c), and (e); and 640.11(b). (f) Documentation. The laboratory must document all control procedures performed, as specified in this section. This STANDARD is not met as evidenced by: Based on a review of immunohematology records, policies, and interview with technical supervisor (TS) #1, the laboratory failed to include the physician's signature for the emergency issuance of four out of four blood units released on February 2, 2024, and June 12, 2024, and failed to document the temperature of seven out of seven blood units reissued from April 10, 2023, to February 27, 2024. Findings: 1. A review of "Blood Bank Transfusion Records" used to record uncrossmatched blood units transfused failed to include the physicians' signature for the emergency issuance of three blood products released on June 12, 2024 (visit #770470020) and one blood product released on February 2, 2024 (visit #770498902) as required by their Emergency Issuance of Blood Products policy. 2. A review of immunohematology records revealed the laboratory failed to take and record the temperature of units not transfused and reissued for service on 4/10/2023 (unit W042323007004), 9/5/2023 (units W042423114692, W042423115731), 12/25/2023 (units W042323026673, W042323028619), and 2/27/24 (units WO04232400464, W042324003012) as required by their Emergency Issuance of Blood Products policy. 3. An interview with TS #1 on October 1, 2024, at 12:00 PM confirmed emergency release documents did not include the physicians' signature, and laboratory staff failed to take and record the temperature of reissued blood products per their policy from April 10, 2023, to February 27, 2024. 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 - December 20, 2022

Survey Type: Standard

Survey Event ID: X6T611

Deficiency Tags: D6063 D6065 D6066 D6063 D6065 D6066

Summary:

Summary Statement of Deficiencies D6063 LABORATORY TESTING PERSONNEL CFR(s): 493.1421 The laboratory must have a sufficient number of individuals who meet the qualification requirements of 493.1423, to perform the functions specified in 493. 1425 for the volume and complexity of tests performed. This CONDITION is not met as evidenced by: Based on record review of the patient results report, testing personnel records, and interview with General Supervisor (GS) #1, the laboratory failed to ensure that seven out of the 14 testing personnel listed on the CMS-209 Personnel Report Form had the appropriate educational background and training prior to performing moderate-level diagnostic tests on the Abbott i-STAT analyzer. (See D6065 and D6066) D6065 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1423(b)(1)(2)(3)(4)(i) (b) Meet one of the following requirements: (b)(1) Be a doctor of medicine or doctor of osteopathy licensed to practice medicine or osteopathy 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; or (b)(2) Have earned an associate degree in a chemical, physical or biological science or medical laboratory technology from an accredited institution; or (b)(3) Be a high school graduate or equivalent and have successfully completed an official military medical laboratory procedures course of at least 50 weeks duration and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Laboratory Technician); or (b)(4)(i) Have earned a high school diploma or equivalent; 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 2 -- This STANDARD is not met as evidenced by: Based on a record review and an interview with the General Supervisor (GS) #1, the laboratory failed to ensure that seven out of the 14 testing personnel (TP) listed on the CMS-209 Personnel Report Form were qualified to perform moderate-level diagnostic testing on the Abbott i-STAT analyzer from January 1, 2021, to December 20, 2022. Findings: 1. A review of accession #21-139-2850 patient results report for venous blood gas performed on 5/19/2021 revealed that the test was performed by testing personnel in the Respiratory Care Unit. 2. The laboratory failed to provide documentation of appropriate education and experience for seven out of the 14 testing personnel (TP #8, TP #9, TP #10, TP #11, TP #12, TP #13, and TP #14) listed on the CLIA CMS-209 form. 3. A review of the test volume report for Abbott i-STAT CG4+ analytes revealed 291 pH, 270 pCO2, and 270 pO2 tests were performed from December 14, 2021, to December 14, 2022. 4. An interview with GS #1 on December 20, 2022, at 1:00 PM confirmed the laboratory failed to verify the qualifications of seven of the 14 testing personnel that performed blood gas analyses from January 1, 2021, to December 20, 2022 D6066 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1423(b)(4)(ii) Have documentation of training appropriate for the testing performed prior to analyzing patient specimens. This STANDARD is not met as evidenced by: Based on a record review and an interview with the General Supervisor (GS) #1, the laboratory failed to ensure that seven out of the 14 testing personnel (TP) listed on the CMS-209 Personnel Report Form had documentation of training applicable to the types and complexity of testing performed on the Abbott i-STAT analyzer from January 1, 2021, to December 20, 2022. Findings: 1. A review of accession #21-139- 2850 patient results report for venous blood gas performed on 5/19/2021 revealed results were reported for analytes pH, pCO2, pO2, SO2, HCO3 and Base Excess (BE). 2. The laboratory failed to provide documentation of training for seven out of the 14 testing personnel (TP #8, TP #9, TP #10, TP #11, TP #12, TP #13, and TP #14) listed on the CLIA CMS-209 form for the Abbott i-STAT analyzer prior to analyzing patient specimens. 3. An interview with GS #1 on December 20, 2022, at 1:00 PM confirmed the laboratory failed to verify the seven of the 14 testing personnel were properly trained to performed blood gas analyses prior to patient testing from January 1, 2021, to December 20, 2022 -- 2 of 2 --

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Survey - April 6, 2021

Survey Type: Standard

Survey Event ID: L5YJ11

Deficiency Tags: D5403 D5439 D5775 D6094 D5403 D5439 D5775 D6094

Summary:

Summary Statement of Deficiencies D5403 PROCEDURE MANUAL CFR(s): 493.1251(b) The procedure manual must include the following when applicable to the test procedure: (1) Requirements for patient preparation; specimen collection, labeling, storage, preservation, transportation, processing, and referral; and criteria for specimen acceptability and rejection as described in 493.1242. (2) Microscopic examination, including the detection of inadequately prepared slides. (3) Step-by-step performance of the procedure, including test calculations and interpretation of results. (4) Preparation of slides, solutions, calibrators, controls, reagents, stains, and other materials used in testing. (5) Calibration and calibration verification procedures. (6) The reportable range for test results for the test system as established or verified in 493.1253. (7) Control procedures. (8)

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Survey - April 25, 2018

Survey Type: Standard

Survey Event ID: 8VJM11

Deficiency Tags: D0000 D3031 D6127 D0000 D3031 D6127

Summary:

Summary Statement of Deficiencies D0000 Based on an on-site recertification survey conducted on 4/25/18, deficiencies were cited for Livingston HealthCare in Livingston, MT. D3031 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(3) Analytic systems records. Retain quality control and patient test records (including instrument printouts, if applicable) and records documenting all analytic systems activities specified in 493.1252 through 493.1289 for at least 2 years. This STANDARD is not met as evidenced by: Based on observation, record review, and interview, the laboratory failed to retain chemistry calibration data and prothrombin time (PT) mean calculation data from 4/45 /16 to 4/25/18. The findings include: 1. PT patient mean a. A Sysmex CA-600 coagulation analyzer was observed in the laboratory on 4/25/18 at 8:45 a.m. b. A review of the test volume report on 4/25/18 at 9:15 a.m. included an annual test volume of 1564 PTs. c. On 4/25/18 at 2:45 p.m. a PT mean patient time of 10.1 seconds was observed on the Sysmex CA-600 analyzer to calculate the patient International Normalized Ratio (INR). d. On 4/25/18 at 2:45 p.m., staff member A stated the data used to calculate the patient mean was logged into the analyzer and overwritten with each new reagent change. e. A review on 4/25/18 at 2:45 p.m. of the coagulation binder lacked the data for the calculation of the patient mean. New lots requiring a patient mean to be re-calculated were started in approximately 3/2018, 3 /2017, and 4/2016. 2. Siemens Advia Centaur CP a. A Siemens Advia Centaur CP analyzer was observed in the laboratory on 4/25/18 at 8:45 a.m. b. On 4/25/18 at 8:45 a.m., staff member B stated the Centaur CP analyzer performs carcinoembryonic antigen (CEA), cortisol, free triiodothyronine (FT3), parathyroid hormone (PTH), prolactin, rubella, total testosterone, vitamin B12, folate, and hepatitis B surface antigen. c. An observation of the calibration data stored on the analyzer on 4/25/18 at 3:15 p.m. for the ten analytes lacked calibration data prior to 4/2017. d. On 4/25/18 at 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 -- 3:15 p.m., staff member B stated the calibrations are printed daily for review and then thrown away. D6127 TECHNICAL SUPERVISOR RESPONSIBILITIES CFR(s): 493.1451(b)(9) The technical supervisor is responsible for evaluating and documenting the performance of individuals responsible for high complexity testing at least semiannually during the first year the individual tests patient specimens. This STANDARD is not met as evidenced by: Based on record review and interview, the technical supervisor failed to evaluate and document semiannual competency assessments for two of three new testing personnel. The findings include: 1. A review on 4/25/18 at 12:05 p.m. of the Livingston HealthCare competency documentation lacked semiannual assessments for staff members C and D. 2. On 4/25/18 at 12:05 p.m., staff member E stated the lab did not perform competency assessments within the first year. -- 2 of 2 --

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