Physicians Immediate Care Center

CLIA Laboratory Citation Details

3
Total Citations
9
Total Deficiencyies
9
Unique D-Tags
CMS Certification Number 13D1096966
Address 134 W Chubbuck Rd, Chubbuck, ID, 83202
City Chubbuck
State ID
Zip Code83202
Phone208 237-7911
Lab DirectorWARREN WILLEY

Citation History (3 surveys)

Survey - January 10, 2022

Survey Type: Standard

Survey Event ID: 7KD911

Deficiency Tags: D5211

Summary:

Summary Statement of Deficiencies D5211 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(a) The laboratory must review and evaluate the results obtained on proficiency testing performed as specified in subpart H of this part. This STANDARD is not met as evidenced by: Based on a record review of proficiency testing (PT) from the Wisconsin State Laboratory of Hygiene (WSLH) and an interview with the technical consultant (TC) on 1/10/2022, the laboratory failed to review and evaluate PT results that were less than 100% but were equal to or greater than 80%. The findings include: 1. A review of PT records from WSLH for 2020 event three identified that the laboratory failed to evaluate results for the analyte hematocrit which had a score of 80%. 2. An interview with the TC on 1/10/2022 at 1:38 pm confirmed that the laboratory failed to evaluate the PT hematocrit results for 2020 event three. 3. The laboratory reports performing 4500 hematology tests annually. 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 - July 22, 2020

Survey Type: Standard

Survey Event ID: H63D11

Deficiency Tags: D5417

Summary:

Summary Statement of Deficiencies D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. This STANDARD is not met as evidenced by: This Standard is not met as evidenced by: Based on observation of laboratory supplies and an interview with the lab manager, the laboratory failed to ensure expired vacutainer serum separator tubes were not available for use. Findings: 1. Observation of laboratory supplies available for use on July 22, 2020 at 1545 hours revealed that approximately 30 Becton Dickinson vacutainer serum separator tubes had expired in October 2019. 2. The laboratory manager confirmed on July 22, 2020 at 1600 hours that expired serum separator tubes were available for use in the laboratory. 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 - April 9, 2018

Survey Type: Standard

Survey Event ID: OTRR11

Deficiency Tags: D2007 D2015 D5221 D5781 D6033 D6035 D6053

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 a record review and an interview with the laboratory supervisor, the laboratory failed to test the Wisconsin State Laboratory of Hygiene (WSLH) proficiency testing (PT) samples for complete blood counts (CBCs) by the same personnel who perform patient testing since the last survey on April 11, 2016. Findings: 1. A WSLH PT record review revealed the laboratory failed to rotate and test the CBC PT samples by the same testing personnel who perform patient testing since the last survey. 2. An interview on April 9, 2018 at 10:30 AM, with the laboratory supervisor, confirmed the laboratory failed to test the CBC proficiency samples from WSLH by personnel who routinely test patient CBCs since the last survey. D2015 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(5)(6) (5) The laboratory must document the handling, preparation, processing, examination, and each step in the testing and reporting of results for all proficiency testing samples. The laboratory must maintain a copy of all records, including a copy of the proficiency testing program report forms used by the laboratory to record proficiency testing results including the attestation statement provided by the PT program, signed by the analyst and the laboratory director, documenting that proficiency testing samples were tested in the same manner as patient specimens, for a minimum of two years from the date of the proficiency testing event. (6) PT is required for only the test Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 4 -- system, assay, or examination used as the primary method for patient testing during the PT event. This STANDARD is not met as evidenced by: Based on a record review and an interview with the laboratory supervisor, the laboratory director failed to sign the attestation statements from the Wisconsin State Laboratory of Hygiene (WSLH) proficiency testing (PT) program, and the laboratory failed to retain complete blood count (CBC) test results from the Medonic analyzer since the last survey on April 11, 2016. Findings: 1. A WSLH PT document review revealed the laboratory director failed to sign the attestation statements for the Hematology and Urinalysis events since the last survey. 2. A WSLH PT document review revealed the laboratory failed to retain CBC PT test results printed from the Medonic analyzer since the last survey. 3. An interview on April 9, 2018, at 10:30 AM, with the laboratory supervisor, confirmed the laboratory director failed to sign the attestation statements from WSLH, and the laboratory failed to retain the CBC PT sample test results since the last survey. D5221 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(d) All proficiency testing evaluation and verification activities must be documented. This STANDARD is not met as evidenced by: Based on proficiency testing (PT) record review and an interview with the laboratory supervisor, the laboratory failed to document the evaluation of unsatisfactory PT results for the wet mount test from the Wisconsin State Laboratory of Hygiene (WSLH) proficiency testing (PT) program 2017 event 1. Findings: 1. A review of PT results from WSLH 2017 event 1, revealed the laboratory failed to document the evaluation and

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