Pediatric Associates Of The Northwest

CLIA Laboratory Citation Details

2
Total Citations
34
Total Deficiencyies
14
Unique D-Tags
CMS Certification Number 38D0622078
Address 7150 Sw Dartmouth Street, Tigard, OR, 97223
City Tigard
State OR
Zip Code97223
Phone(503) 968-3480

Citation History (2 surveys)

Survey - October 12, 2020

Survey Type: Standard

Survey Event ID: LP7C11

Deficiency Tags: D2007 D2009 D3011 D5200 D5209 D5291 D5413 D6029 D6033 D6046 D6076 D6094 D2007 D2009 D3011 D5200 D5209 D5291 D5413 D6029 D6033 D6046 D6076 D6094

Summary:

Summary Statement of Deficiencies D2007 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) The samples must be examined or tested with the laboratory's regular patient workload by personnel who routinely perform the testing in the laboratory, using the laboratory's routine methods This STANDARD is not met as evidenced by: Based on review of Proficiency Testing (PT) documents provided for review during survey and discussion with the Technical Consultant (TC), the laboratory failed to ensure PT samples were rotated among testing personnel (TP). Findings include: 1. Upon review of the PT documentation for all three (3) events in 2020, the laboratory failed to rotate the PT events with different TP. 2. One TP out of seven (7) performed all three (3) PT events in 2020. 3. An interview with the TC on 10/12/20 at approximately 1200 confirmed this. D2009 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) The individual testing or examining the samples and the laboratory director must attest to the routine integration of the samples into the patient workload using the laboratory's routine methods. This STANDARD is not met as evidenced by: Based on review of Proficiency Testing (PT) documents for 2018, 2019, and 2020, the laboratory failed to ensure the attestation form was signed by the Laboratory Director (LD) each time PT was performed and submitted. Findings include: 1. Seven (7) PT events were examined during survey, three (3) for 2020, three (3) for 2019 and one (1) for 2018. Three (3) out of seven (7) had no attestation form signed and available for Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 5 -- review during survey 10/12/2020. 2. An interview with the TC on 10/12/20 at approximately 1200 confirmed this. D3011 FACILITIES CFR(s): 493.1101(d) Safety procedures must be established, accessible, and observed to ensure protection from physical, chemical, biochemical, and electrical hazards, and biohazardous materials. This STANDARD is not met as evidenced by: Based on review of safety records and interview with one Testing Personnel (TP), the laboratory failed to ensure the eyewash equipment was tested weekly according to laboratory policy. Findings include: 1. Upon review of the written records for checking the eye wash weekly, it was noted that the eye wash had not been checked by TP since the first week of September 2020, creating a possible safety hazard if it was inoperable. 2. The one TP interviewed during survey 10/12/2020 confirmed it had not been done. D5200 GENERAL LABORATORY SYSTEMS CFR(s): 493.1230 Each laboratory that performs nonwaived testing must meet the applicable general laboratory systems requirements in 493.1231 through 493.1236, unless HHS approves a procedure, specified in Appendix C of the State Operations Manual (CMS Pub. 7), that provides equivalent quality testing. The laboratory must monitor and evaluate the overall quality of the general laboratory systems and correct identified problems specified in 493.1239 for each specialty and subspecialty of testing performed. This CONDITION is not met as evidenced by: Based on review of the quarterly Quality Assurance (QA) policy and QA records available for review during survey, the Technical Consultant (TC) failed to follow the laboratory's policy for quarterly QA review. Findings include: 1. The written policy for performing quarterly QA assessment submitted as a part of their

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Survey - August 7, 2018

Survey Type: Standard

Survey Event ID: XOIZ11

Deficiency Tags: D2009 D5291 D5403 D6084 D6094 D2009 D5291 D5403 D6084 D6094

Summary:

Summary Statement of Deficiencies D2009 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) The individual testing or examining the samples and the laboratory director must attest to the routine integration of the samples into the patient workload using the laboratory's routine methods. This STANDARD is not met as evidenced by: Based on review of Proficiency Testing (PT) records and discussion with staff, the Laboratory Director (LD) failed to sign the attestation form as required by CFR 493.801(b). Findings include: 1. Attestation forms #1 through #3 for 2017 were signed by a Medical Assistant. 2. Attestation forms #1 and #2 for 2018 were signed by a Medical Assistant. 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 review of this laboratory's procedure for Quality Assurance (QA) and discussion with the Technical Consultant (TC), the laboratory failed to document monthly QA activities as outlined in their procedure. Findings include: 1. The laboratory's procedure for QA provides a checklist that is to be completed monthly. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 3 -- There was no written documentation on the checklist for the year (12 months) 2017 and 2018 to date (7 months). 2. The TC confirmed that no written documentation (the checklist) had been done since the last survey during interview on 8/7/2018 at ~1200. D5403 PROCEDURE MANUAL CFR(s): 493.1251(b) The procedure manual must include the following when applicable to the test procedure: (1) Requirements for patient preparation; specimen collection, labeling, storage, preservation, transportation, processing, and referral; and criteria for specimen acceptability and rejection as described in 493.1242. (2) Microscopic examination, including the detection of inadequately prepared slides. (3) Step-by-step performance of the procedure, including test calculations and interpretation of results. (4) Preparation of slides, solutions, calibrators, controls, reagents, stains, and other materials used in testing. (5) Calibration and calibration verification procedures. (6) The reportable range for test results for the test system as established or verified in 493.1253. (7) Control procedures. (8)

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