Peds Care Pc

CLIA Laboratory Citation Details

3
Total Citations
10
Total Deficiencyies
8
Unique D-Tags
CMS Certification Number 11D0262347
Address 1933 Shields Road, Dalton, GA, 30720
City Dalton
State GA
Zip Code30720
Phone706 278-6628
Lab DirectorRICARDO RIESCO

Citation History (3 surveys)

Survey - November 15, 2023

Survey Type: Standard

Survey Event ID: NVV211

Deficiency Tags: D6053 D0000

Summary:

Summary Statement of Deficiencies D0000 A recertification survey was performed on November 15, 2023. The facility was found to be NOT in compliance with all applicable CLIA requirements for specialties /subspecialties for 42 CFR. D6053 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing at least semiannually during the first year the individual tests patient specimens. This STANDARD is not met as evidenced by: Based on review of testing personnel (TP) documents and an interview with testing personnel, the technical consultant (CMS 209 form) failed to perform semiannual competency on all testing personnel. Findings: 1. Review of the TP competency documents disclosed TP#17 (CMS 209 form) did not have a semiannual competency completed. (Documented competencies were performed on 7/29/22 and 7/30/23.) 2. Interview with TP #9 (CMS 209 form) on 11/15/23 in the extra project office at 11:30 am, confirmed the TP did not have a semiannual competency. 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 - December 16, 2021

Survey Type: Standard

Survey Event ID: HOJI11

Deficiency Tags: D0000 D6032 D5311 D6046

Summary:

Summary Statement of Deficiencies D0000 A Clinical Laboratory Improvement Amendments (CLIA) recertification survey was completed on December 16, 2021. The laboratory was not in compliance with applicable CLIA requirements found at 42 CFR 493.1 through 42 CFR 493.1780. The following deficiencies were cited: D5311 SPECIMEN SUBMISSION, HANDLING, AND REFERRAL CFR(s): 493.1242(a) The laboratory must establish and follow written policies and procedures for each of the following, if applicable: (1) Patient preparation. (2) Specimen collection. (3) Specimen labeling, including patient name or unique patient identifier and, when appropriate, specimen source. (4) Specimen storage and preservation. (5) Conditions for specimen transportation. (6) Specimen processing. (7) Specimen acceptability and rejection. (8) Specimen referral. This STANDARD is not met as evidenced by: Based on review of the laboratory procedure manual and interview with Testing Personnel(TP), the laboratory failed to establish written instructions for sending specimens to an outside reference laboratory for testing. The findings include: 1. The laboratory's procedure manual did not include a written policy and procedure to include: collection, preservation, storage, transport, testing schedule times, or how to obtain additional assistance for staff to follow when sending specimens to reference laboratories (Hamilton, Diathrix, and Medtox). 2. During an interview, on December 16, 2021, at 2:00 PM, TP #6 and #9(CMS 209), in a back office, near the breakroom, confirmed that the laboratory did not have a written policy and procedure for staff to follow when sending specimens to a reference laboratory. D6032 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(14) 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 -- The laboratory director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, and record and report test results promptly, accurate, and proficiently and for assuring compliance with the applicable regulations. (e) The laboratory director must-- (e)(14) Specify, in writing, the responsibilities and duties of each consultant and each person, engaged in the performance of the preanalytic, analytic, and postanalytic phases of testing, that identifies which examinations and procedures each individual is authorized to perform, whether supervision is required for specimen processing, test performance or results reporting, and whether consultant or director review is required prior to reporting patient test results. This STANDARD is not met as evidenced by: Based on review of the laboratory policy and procedure manual (SOP) and staff interview, the laboratory director (LD) failed to specify, in writing, the duties and responsibilities of each person engaged in the performance of the pre-analytic, analytic, and post-analytic phases of laboratory testing. Findings include: 1. SOP review revealed the LD failed to specify in writing the duties and responsibilities of each person engaged in the performance of all phases of laboratory testing. 2. During an interview with Testing Personnel #6 and #9(CMS 209), on December 16, 2021,at approximately 2:05 PM, in a back office , near the breakroom, confirmed the SOP did not contain the duties and responsibilities policy and procedure for all personnel engaged in the performance of clinical laboratory testing. D6046 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(8) (b) The technical consultant is responsible for-- (b)(8) Evaluating the competency of all testing personnel and assuring that the staff maintain their competency to perform test procedures and report test results promptly, accurately and proficiently. This STANDARD is not met as evidenced by: Based on review of the laboratory's testing personnel competency assessment checklist as well as interview with the the supervisors, the laboratory failed to ensure the competency assessment policy and procedure for testing performed in the speciality of Microbiology to have met the 6 required criteria. The Findings include: 1. Laboratory document review revealed the laboratory was performing competency, but their competency assessment checklist did not include the 6 required criteria for the specialty of Microbiology. 2. During an interview with Testing Personnel #6 and #9(CMS 209) on December 16, 2021 at approximately 2:10 PM, confirmed that the laboratory was performing competency on the testing personnel, but it did not follow the 6 required criteria for the specialty of Microbiology. -- 2 of 2 --

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Survey - June 17, 2019

Survey Type: Standard

Survey Event ID: YSCI11

Deficiency Tags: D3011 D6049 D0000 D5477

Summary:

Summary Statement of Deficiencies D0000 A Clinical Laboratory Improvement Amendments (CLIA) recertification survey was completed on June 17, 2019. The laboratory was not in compliance with applicable CLIA requirements found at 42 CFR 493.1 through 42 CFR 493.1780. The following deficiencies were cited: 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 observation and interview with the nurse manager, the laboratory failed to implement and establish safety procedure to ensure protection from physical, biochemical, and biohazardous materials. Findings include: 1. During the laboratory tour it was observed that there was not a formal installed eyewash station and maintenance log for the eyewash in the laboratory testing area. 2. An interview with the nurse manager on 06/17/2019 at approximately 11:35 a.m. confirmed a formal eyewash station was not installed in the laboratory and there was no weekly maintenance log to go with it. D5477 CONTROL PROCEDURES CFR(s): 493.1256(e)(4)(g) (e) For reagent, media, and supply checks, the laboratory must do the following: (e) (4) Before, or concurrent with the initial use-- (e)(4)(i) Check each batch of media for sterility if sterility is required for testing; (e)(4)(ii) Check each batch of media for its ability to support growth and, as appropriate, select or inhibit specific organisms or produce a biochemical response; and (e)(4)(iii) Document the physical characteristics 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 the media when compromised and report any deterioration in the media to the manufacturer. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Based on quality control (QC) document review and staff interview, the laboratory failed to perform QC in bacteriology as required. Findings include: 1. QC document review revealed the laboratory failed to perform an incubated sterility check for the bacteriology media from September 2017 to June 2019. 3. An interview with the nurse manager in the breakroom on 6/17/19 at approximately 11:30 a.m. confirmed the aforementioned QC was not performed from September 2017 to June 2019. D6049 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(8)(iii) The procedures for evaluation of the competency of the staff must include, but are not limited to review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records. This STANDARD is not met as evidenced by: Based on review of the laboratory's maintenance and Quality Assurance(QA) records and an interview with the nurse manager, the Technical Consultant (TC) who is also the laboratory director failed to review and sign Monthly Quality Assurance report records from September 2017 to June 2019. Findings include: 1. Review of maintenance and Quality Assurance reports revealed QA logs were not reviewed and signed from September 2017 to June 2019 by the (TC). 2. An interview with the nurse manager on 06/17/2019 at approximately 11:40 am in the review room confirmed that maintenance QA reports were not reviewed and signed by the (TC) from September 2017 to June 2019. -- 2 of 2 --

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