Modoc Medical Center

CLIA Laboratory Citation Details

3
Total Citations
6
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 05D0618592
Address 1111 N Nagle St, Alturas, CA, 96101
City Alturas
State CA
Zip Code96101
Phone(530) 708-8800

Citation History (3 surveys)

Survey - October 2, 2025

Survey Type: Standard

Survey Event ID: F53L11

Deficiency Tags: D2173

Summary:

Summary Statement of Deficiencies D2173 COMPATIBILITY TESTING CFR(s): 493.863(a) (a) Failure to attain an overall testing event score of at least 100 percent is unsatisfactory performance. This STANDARD is not met as evidenced by: Based on review of the laboratory's proficiency testing (PT) records, and interview with the Technical Supervisor (TS) on October 2, 2025, it was determined that the laboratory failed to attain a score of at least 100 percent of acceptable responses for PT testing for subspecialty of Compatibility testing in the first event of 2024. The findings included: 1. It was the practice of the laboratory to perform high complexity testing in the specialty of immunohematology and subspecialty of Compatibility testing and the laboratory enrolled in the American Proficiency Institute (API) proficiency testing (PT) program for this specialty. 2. According to the API evaluation report, the laboratory received unsatisfactory scores of 80% for compatibility testing in the first event of 2024. 3. October 2, 2025, at approximately 10:00 am, the TS confirmed that the laboratory received the above unsatisfactory proficiency scores. 4. The laboratory's testing declaration form, signed by the laboratory director on September 12, 2025, stated that the laboratory performed approximately 495 immunohematology tests annually. 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 - March 8, 2022

Survey Type: Standard

Survey Event ID: E2O811

Deficiency Tags: D2121

Summary:

Summary Statement of Deficiencies D2121 HEMATOLOGY CFR(s): 493.851(a) Failure to attain a score of at least 80 percent of acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the testing event. This STANDARD is not met as evidenced by: Based on the surveyor's review of the laboratory's records for evaluation of proficiency testing performance and an interview with laboratory personnel (LP) on 3 /8/22 between 3:00 p.m. and 5:00 p.m, it was determined that the Cell I.D. WBC Diff proficiency scores were below acceptable (80%) for one event (Cycle 3 2020). Findings include: 1. On 3/8/22, an inspection was conducted between 3:00 p.m. and 5: 00 p.m. 2. During a review of the laboratory documentation from API (American Proficiency Institute- the agency providing the proficiency specimens), it was noted at approximately 4:00 p.m. that the laboratory had unacceptable Hematology results for samples XE-11 to XE-15 focused on Cell ID/Differential parameters for Cycle 3 in 2020. The testing was completed on a Sysmex XN-550. 3. The findings and acceptable ranges were as follows: Test: Basophils Sample Actual Result Expected Result (range) XE-11 0.0 4.9-7.2 XE-12 0.7 4.3-6.7 XE-13 1.0 4.9-7.2 XE-14 0.7 5.0- 7.2 XE-15 0.0 4.8-7.4 Test: Eosinophils Sample Actual Result Expected Result (range) XE-11 0.0 8.4-13.4 XE-12 0.3 7.4-12.0 XE-13 1.8 8.3-13.2 XE-14 1.6 8.4- 13.2 XE-15 0.0 8.4-13.5 Test: IG Absolute Sample Actual Result Expected Result (range) XE-11 0.14 0.79-1.01 XE-12 0.01 0.25-0.34 XE-13 0.06 0.68-0.87 XE-14 0.23 1.77-2.23 XE-15 0.04 0.32-0.43 Test: Neutrophils Sample Actual Result Expected Result (range) XE-11 63.4 41.3-46.6 XE-12 57.5 36.9-43.4 XE-13 61.1 41.5- 47.2 XE-14 63.4 41.5-47.1 XE-15 63.5 41.0-47.3 Test: RDW-CV Sample Actual Result Expected Result (range) XE-11 14.7 15.7-16.5 XE-12 13.3 14.3-15.1 XE-13 13.6 14.5-15.3 XE-14 12.2 13.2-14.0 XE-15 12.9 13.8-14.8 . Test: RDW-CV Sample Actual Result Expected Result (range) XE-11 14.7 15.7-16.5 XE-12 13.3 14.3-15.1 XE-13 13.6 14.5-15.3 XE-14 12.2 13.2-14.0 XE-15 12.9 13.8-14.8 Test: RDW-SD 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 -- Sample Actual Result Expected Result (range) XE-11 40.2 43.8-47.2 XE-12 10.8 44.4- 47.6 XE-13 41.8 45.8-49.5 XE-14 39.6 43.0-47.4 XE-15 40.8 44.6-47.5 4. The LP recognized the above results. -- 2 of 2 --

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Survey - October 22, 2019

Survey Type: Standard

Survey Event ID: HPC411

Deficiency Tags: D2087 D5217 D2020 D2173

Summary:

Summary Statement of Deficiencies D2020 BACTERIOLOGY CFR(s): 493.823(a) Failure to attain an overall testing event score of at least 80 percent is unsatisfactory performance. This STANDARD is not met as evidenced by: Based on review of the American Proficiency Institute (API) proficiency testing report, random patient test results, and interview with the technical consultant, it was determined that; the laboratory failed to attain an overall testing event score of at least 80 percent in Bacteriology. The findings included: a. Q3-2018, API reported an unsatisfactory score of 0% for Sputum Culture and 50% for Wound Culture-Aerobic. b. For eight (8) out of eight (8) random patient test results reviewed covering period from 11/21/2017 to 4/4/2019, the laboratory analyzed and reported during the time the laboratory failed the above proficiency testing in Bacteriology. c. The technical consultant confirmed (10/22/2019, 1100), that the laboratory received the above unsatisfactory proficiency testing scores. D2087 ROUTINE CHEMISTRY CFR(s): 493.841(a) Failure to attain a score of at least 80 percent of acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the testing event. This STANDARD is not met as evidenced by: Based on review of the American Proficiency Institute (API) proficiency testing report, and interview with the technical consultant, it was determined that; the laboratory failed to attain a score of at least 80 percent of acceptable responses for PO2 analyte. The findings included: a. Q1-2019, API reported an unsatisfactory score 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 -- of 60% for PO2. b. For two (2) out of two (2) random patient test results reviewed covering period from 3/12/2019 to 4/4/2019 the laboratory analyzed and reported PO2 test during the approximate time the laboratory failed the proficiency testing challenges for PO2 analyte. c. The technical consultant confirmed (10/22/2019, 1100), that the laboratory received the above unsatisfactory proficiency testing score. D2173 COMPATIBILITY TESTING CFR(s): 493.863(a) Failure to attain an overall testing event score of at least 100 percent is unsatisfactory performance. This STANDARD is not met as evidenced by: Based on review of the American Proficiency Institute (API), and interview with the technical consultant, it was determined that; the laboratory failed to attain an overall testing event score of at least 100 percent for Compatibility testing. The findings included: a. Q2-2019, API reported an unsatisfactory score of 60% for Compatibility testing. b. Based on the laboratory's annual testing volume submitted for 2017-2019, the laboratory analyzed and reported 50 Compatibility tests. c. The technical consultant confirmed (10/22/2019, 1100), that the laboratory received the above unsatisfactory proficiency testing score. 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 review of the American Proficiency Institute (API), College, and interview with the technical consultant, it was determined that; the laboratory failed to 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. The findings included: Hematology: a. API reported the following unsatisfactory proficiency testing scores. Analyte: Score: Event/Year: Urine Sediment 25% Q1/2018 CSF Mono 50% Q1/2018 CSF Neut 50% Q1/2018 Sed Rate 50% Q2/2018 CSF Mono 50% Q3-2018 Chemistry Analyte: Score: Event/Year: Acetone 60% Q2/2018 b. Based on the laboratory's annual testing volume submitted for 2017-2019, the laboratory analyzed and reported 66,000 Hematology tests which included the above failed analytes, and 73,000 Routine Chemistry tests which included Acetone tests. c. The technical consultant confirmed (10/22/2019, 1100) that the laboratory received the above unsatisfactory proficiency testing scores. -- 2 of 2 --

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