Summary:
Summary Statement of Deficiencies D0000 An announced CLIA onsite recertification survey was conducted at MUSC-PC Northwoods Lab on January 07, 2026, by South Carolina Department of Public Health (SC DPH), Bureau of Nursing Homes and Medical Services. The facility was found to be out of compliance with the Medicare Condition at 42 CFR Part 493. CLIA laboratory requirements. The following STANDARD LEVEL DEFICINCIES were found to be out of compliance: D5291 GENERAL LABORATORY SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1239(a) The laboratory must establish and follow written policies and procedures for an ongoing mechanism to monitor, assess, and, when indicated, correct problems identified in the general laboratory systems requirements specified at 493.1231 through 493.1236. This STANDARD is not met as evidenced by: Based on record review, lack of documentation, and staff interviews, the laboratory failed to document ongoing review of all facets of the laboratory's monitoring of