Nevada Medical Clinic

CLIA Laboratory Citation Details

2
Total Citations
6
Total Deficiencyies
3
Unique D-Tags
CMS Certification Number 26D0681861
Address 900 S Adams St, Nevada, MO, 64772
City Nevada
State MO
Zip Code64772
Phone(417) 667-6015

Citation History (2 surveys)

Survey - October 28, 2019

Survey Type: Special

Survey Event ID: R2X111

Deficiency Tags: D2016 D2096 D2016 D2096

Summary:

Summary Statement of Deficiencies 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 review of 2019 chemistry proficiency testing (PT) results reported to the CLIA database by the PT provider and phone interview with the laboratory director, the laboratory failed to successfully participate in PT. See D-tag 2096, unsatisfactory performance in three consecutive total cholesterol PT challenges. D2096 ROUTINE CHEMISTRY CFR(s): 493.841(f) Failure to achieve satisfactory performance for the same analyte or test in two 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 -- consecutive testing events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on review of chemistry proficiency testing (PT) results for 2019 and phone interview with the laboratory director, the laboratory failed to achieve satisfactory performance for the total cholesterol analyte testing in three consecutive PT events. Findings: 1. Review of the chemistry PT results for the first event of 2019 revealed the laboratory obtained an unsatisfactory score of 40 percent for the analyte, total cholesterol. 2. Review of the chemistry PT results for the second event of 2019 revealed the laboratory obtained an unsatisfactory score of 60 percent for total cholesterol. 3. Review of the chemistry PT results for the third event of 2019 revealed the laboratory obtained an unsatisfactory score of 60 percent for total cholesterol. 3. Phone interview with the laboratory director on October 24, 2019 at 3:30 PM confirmed the laboratory failed to achieve satisfactory performance for total cholesterol testing in three consecutive events for 2019. -- 2 of 2 --

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Survey - May 3, 2018

Survey Type: Standard

Survey Event ID: 6GBV11

Deficiency Tags: D5413 D5413

Summary:

Summary Statement of Deficiencies 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 manufacturer's instructions, documentation of freezer temperatures and observation of quality control (QC) material stored in the freezer revealed, and interview with the laboratory director confirmed, the laboratory failed to follow the manufacturer's instructions for storage of control material for 7 of 66 testing days since February 1, 2018 through May 3, 2018. Findings: 1. Review of the manufacturer's instructions for Bio-Rad liquichek specialty immunoassay control and Bio-Rad liquichek immunoassay plus control states controls must be stored at minus 20 degrees Celsius (C) to minus 70 degrees C. 2. Review of the laboratory's temperature chart showed a defined acceptable range of minus 25 degrees C +/- 6 degrees C. 7 of 66 testing days that failed to meet the manufacturer's required minus 20 to minus 70 degree C range. 3. Observation of the laboratory freezer showed 1 box of Bio-Rad liquichek immunoassay control level I(lot # 40941), 1 box of Bio-Rad liquichek immunoassay control level III(lot #40943), 1 box Bio-Rad liquichek immunoassay control level II(lot 40942) and 1 box level III(lot 60233) Bio-Rad liquichek specialty immunoassay control, 1 box Bio-Rad liquichek specialty immunoassay control level I(lot 60231) and 1 box level II(lot 60232) Bio-Rad liquichek specialty immunoassay control currently in use in the laboratory. 4. Interview with the laboratory director on May 3, 2018 at 11:00 AM confirmed 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 -- laboratory failed to properly monitor the freezer and store QC materials and supplies per manufacturer's instructions. -- 2 of 2 --

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