Northshore Clinical Laboratories,

CLIA Laboratory Citation Details

2
Total Citations
3
Total Deficiencyies
3
Unique D-Tags
CMS Certification Number 14D0426602
Address 4751 N Kedzie Ave, Chicago, IL, 60625
City Chicago
State IL
Zip Code60625
Phone(773) 570-6510

Citation History (2 surveys)

Survey - May 24, 2021

Survey Type: Standard

Survey Event ID: CC2H11

Deficiency Tags: D6090

Summary:

Summary Statement of Deficiencies D6090 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1445(e)(4)(ii) The laboratory director must ensure the results are returned within the timeframes established by the proficiency testing program. This STANDARD is not met as evidenced by: Based on record review, CASPER Report 0155D, and interview with technical supervisor (TS1); the laboratory director (LD) failed to ensure proficiency testing (PT) results are returned within the timeframes established by the proficiency testing programs. Findings include: 1. The Report 0155D, American Proficiency Institute (API) and WSLH PT reports for the years 2019, 2020, and 2021, and the laboratory's PT policies and procedures were reviewed. 2. The Report 0155D revealed the following scores for Event #3 of 2020: General Immunology: Antinuclear Antibody (ANA) = 0* Hematology: Cell Identification (I.D) or White Blood Cell (WBC) differential (Diff) = 0* Red Blood Cell Count (RBC) = 0* Hemoglobin (HGB) = 0* Hematocrit (HCT) = 0* White Blood Cell Count (WBC) = 0* Platelets = 0* Endocrinology: Human chorionic gonadotropin (HCG) - 0* 3. The API and WSLH PT reports showed the above "0*" scores were due to late or failed submissions of PT results to the proficiency programs. 4. The LD failed to ensure the laboratory followed its PT policies and procedures to submit all PT results before the PT programs' deadlines. 5. On a Recertification survey conducted on 05/24/2021 at 2:45 PM, the TS1 confirmed the above findings. 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 - January 5, 2021

Survey Type: Special

Survey Event ID: 1S6D11

Deficiency Tags: D2016 D2130

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 the CASPER Report 155D (Individual Laboratory Proficiency Testing Profile) and phone interview with an American Proficiency Institute (API) program representative; the laboratory failed to successfully participate in the PT program for the Specialty of Hematology during calendar year 2020. Findings include: 1. Review of the CASPER Report 155D on January 05, 2021 and communication with the PT vendor API at 1:40 PM, the initial unsuccessful PT performance was confirmed under the Specialty of Hematology for the analytes red blood cells and prothrombin time. See D2130. 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 -- D2130 HEMATOLOGY CFR(s): 493.851(f) Failure to achieve satisfactory performance for the same analyte in two consecutive events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on review of the CASPER Report 155D (Individual Laboratory Proficiency Testing Profile) and interview with the PT vendor American Proficiency Institute (API) confirmed the laboratory failed to successfully participate in the testing of proficiency testing samples under the Specialty of Hematology for the analytes Prothrombin Time and Red Blood Cells during the calendar year 2020. Findings include: 1. Review of the CASPER Report 155D on January 05, 2021 revealed that the initial unsuccessful PT performance occurred under the Specialty of Hematology for Prothrombin Time and Red Blood Cells during events 2 and 3 of 2020 as listed below: HEMATOLOGY Prothrombin Time EVENT -2, 2020 = 60% Unsuccessful Prothrombin Time EVENT -3, 2020 = 0% Unsuccessful Red Blood Cells EVENT -2, 2020 = 60% Unsuccessful Red Blood Cells EVENT -3, 2020 = 0% Unsuccessful 2. During a phone interview with the PT vendor API on January 05, 2021 at 1:40 PM, they confirmed the above PT scores for Prothrombin Time and Red Blood Cells for events 2 and 3 of 2020. -- 2 of 2 --

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