Michael Tahery Md, Inc

CLIA Laboratory Citation Details

2
Total Citations
4
Total Deficiencyies
4
Unique D-Tags
CMS Certification Number 05D0940223
Address 503 N Central Ave Ste 200, Glendale, CA, 91203
City Glendale
State CA
Zip Code91203
Phone(818) 265-9499

Citation History (2 surveys)

Survey - November 4, 2021

Survey Type: Standard

Survey Event ID: 9N2811

Deficiency Tags: D5415 D6179 D5433

Summary:

Summary Statement of Deficiencies D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(c) Reagents, solutions, culture media, control materials, calibration materials, and other supplies, as appropriate, must be labeled to indicate the following: (1) Identity and when significant, titer, strength or concentration. (2) Storage requirements. (3) Preparation and expiration dates. (4) Other pertinent information required for proper use. This STANDARD is not met as evidenced by: Based on observation of the laboratory's reagent materials in the Bacteriology laboratory and interview with the laboratory's testing personnel (TP); it was determined that the laboratory failed to label reagents to indicate the opening date, preparation, and expiration dates, when such reagents are used. The findings included: 1. Based on the surveyor's observation during the laboratory tour on November 4, 2021 at approximately 11:30 a.m., the TP indicated that no opening, preparation, or expiration date labels were documented as well as initials of the person preparing the reagents for all the reagents used in the Microbiology laboratory (oxidase, catalase, indole, etc.). 2. The laboratory's TP affirmed in an interview conducted November 4, 2021 at approximately 12:00 p.m., that the reagents currently used to test patients' samples in the microbiology section were not labeled with opening, preparation, initials, and expiration dates. 3. Based on the laboratory's annual testing declaration submitted at the time of the survey, the laboratory analyzed approximately 1,210 microbiology samples annually. D5433 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(1) For equipment, instruments, or test systems developed in-house, commercially available and modified by the laboratory, or maintenance and function check 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 -- protocols are not provided by the manufacturer, the laboratory must establish a maintenance protocol that ensures equipment, instrument, and test system performance that is necessary for accurate and reliable test results and test result reporting. The laboratory must perform and document the maintenance activities specified in paragraph (b)(1)(i) of this section. This STANDARD is not met as evidenced by: Based on the surveyor's observation, lack of maintenance protocol and documentation, and interview with the testing personnel (TP) it was determined that the laboratory failed to establish and document a maintenance protocol for the desiccant used in the container with antimicrobials testing discs used for susceptibility testing of bacterial organisms. The findings included: 1. The laboratory used various antimicrobial panels to test for susceptibility testing on bacteria isolated. 2. At the time of the laboratory tour on November 4, 2021 at approximately 11:30 a.m. the surveyor observed that the antimicrobials were stored in a plastic container with no desiccants to preserve the strength and potency of the antibiotic discs. 3. The TP affirmed that the laboratory failed to establish a maintenance protocol (placing of desiccants and changing them as needed in the container) for the antimicrobials' storage. 4. Based on the laboratory's testing declaration submitted at the time of the survey, the laboratory analyzed and reported approximately 1,090 bacteriology samples annually for which a antibiotic susceptibilities are performed on a number of bacterial isolates. D6179 TESTING PERSONNEL RESPONSIBILITIES CFR(s): 493.1495(b)(5) Each individual performing high complexity testing must be capable of identifying problems that may adversely affect test performance or reporting of test results and either must correct the problems or immediately notify the general supervisor, clinical consultant, or director. This STANDARD is not met as evidenced by: Based on the surveyor's observation, review of policies and procedures, and interview with the technical supervisor/testing person; it was determined that the testing personnel failed to identify problems that could adversely affect test performance and reporting of test results. See D5415 and D5433. -- 2 of 2 --

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Survey - June 18, 2019

Survey Type: Standard

Survey Event ID: JYAZ11

Deficiency Tags: D5301

Summary:

Summary Statement of Deficiencies D5301 TEST REQUEST CFR(s): 493.1241(a) The laboratory must have a written or electronic request for patient testing from an authorized person. This STANDARD is not met as evidenced by: Based on request, review of random patient sampling test orders, and interview with the technical consultant, it was determined that the laboratory failed to have a written or electronic request for patient testing from an authorized person. The findings included: a. During the survey 6/18/2019 the laboratory has no documentation to show of a test order from an authorized person. b. For three (3) out of three (3) random patient test orders reviewed covering period from 5/28/2019 to 6/5/2019, the laboratory analyzed and reported Testosterone, SHBG, Estradiol, Progesterone, FSH, LH, TSH, DHEA-SO4, Vitamin D, Free T3 and Free T4 tests without a written or electronic request for patient testing from an authorized person. Note: Abbreviations Dehydroepiandrosterone Sulfate (DHEA-SO4) Follicle Stimulating Hormone (FSH) Luteinizing Hormone (LH) Thyroid Stimulating Hormone (TSH) Triiodothyronine (T3) Thyroxine (T4) Sex Hormone Binding Globulin (SHBG) c. The technical consultant confirmed (6/18/2019, 12:45PM) that the laboratory has no documentation to show for a written or electronic request for the above patient test results from an authorized person. 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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