Ridgewood Medical Clinic

CLIA Laboratory Citation Details

4
Total Citations
22
Total Deficiencyies
11
Unique D-Tags
CMS Certification Number 45D1003967
Address 219 W Kingsley Rd Ste 336, Garland, TX, 75041
City Garland
State TX
Zip Code75041
Phone972 271-5544
Lab DirectorBLAKE ROGERS

Citation History (4 surveys)

Survey - January 13, 2026

Survey Type: Special

Survey Event ID: OVTV11

Deficiency Tags: D0000 D2130 D6016 D2016 D6000

Summary:

Summary Statement of Deficiencies D0000 The following deficiencies are a result of a desk review of proficiency testing scores obtained from the CMS (Centers for Medicare and Medicaid Services) national database and verified with the proficiency testing company, AAB-MLE (American Association of Bioanalysts Medical Laboratory Evaluation). The laboratory was found to be NOT in compliance with the conditions of participation of the CLIA program based for the following CONDITION LEVEL DEFICIENCIES: 493.803 Successful participation, proficiency testing 493.1403 Laboratory Director, Moderate Complexity 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 a desk review of proficiency testing records, the laboratory failed to 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 -- successfully participate in a proficiency testing program approved by HHS, for each specialty, subspecialty, and analyte or test in which the laboratory is certified under CLIA. The laboratory failed to successfully participate in two of three hematology proficiency testing events for the red blood cell (RBC) analyte. D2130 HEMATOLOGY CFR(s): 493.851(f) (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 a proficiency testing desk review of the CASPER- 0155 Individual Laboratory Report obtained from the CMS national database and AAB-MLE 2025 (1st and 3rd events) records, the laboratory failed to achieve satisfactory performance (100%) for the same analyte in two out of three consecutive testing events in the specialty of hematology for the RBC analyte. Two of three consecutive unsatisfactory scores result in unsuccessful PT performance. The findings include: 1. Review of the CASPER- 0155 report revealed the following: RBC 2025 - 1st Event Laboratory received an unsatisfactory score of 60% RBC 2025 - 3rd Event Laboratory received an unsatisfactory score of 40% 2. A proficiency testing desk review from AAB-MLE 2025 proficiency testing records confirmed the above findings. Word Key: CASPER- Certification and Survey Provider Enhanced Reporting CMS- Centers for Medicare and Medicaid AAB-MLE- American Association of Bioanalysts Medical Laboratory Evaluation RBC- red blood cell D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR CFR(s): 493.1403 The laboratory must have a director who meets the qualification requirements of 493. 1405 of this subpart and provides overall management and direction in accordance with 493.1407 of this subpart. This CONDITION is not met as evidenced by: Based on a desk review of laboratory proficiency testing performance, it was determined that the laboratory director failed to provide overall management and direction of the laboratory services. The laboratory failed to successfully participate in two of three hematology proficiency testing events for the red blood cell (RBC) count analyte. Refer to D6016. D6016 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(4)(i) (e)(4)(i) The proficiency testing samples are tested as required under Subpart H of this part; This STANDARD is not met as evidenced by: Based on a desk review of proficiency testing results it was determined that the laboratory director failed to ensure the overall quality of the laboratory services provided. The laboratory director failed to ensure successful participation in an HHS -- 2 of 3 -- approved proficiency testing program. The laboratory failed to successfully participate in two of three hematology proficiency testing events for the red blood cell (RBC) count analyte. Refer to D2130. -- 3 of 3 --

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Survey - July 23, 2024

Survey Type: Standard

Survey Event ID: 2J7Y11

Deficiency Tags: D0000 D5783 D5783

Summary:

Summary Statement of Deficiencies D0000 The laboratory was found to be in substantial compliance with CLIA regulations 42 CFR Part 493. Standard level deficiencies were cited. D5783

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Survey - September 1, 2022

Survey Type: Standard

Survey Event ID: OM0B11

Deficiency Tags: D0000 D5421 D0000 D5421

Summary:

Summary Statement of Deficiencies D0000 Noted deficiencies and plans of correction were discussed with the laboratory representative(s) at the exit conference. The facility was found to be in compliance with applicable Conditions of Participation in the CLIA program, and recertification is recommended. . D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE CFR(s): 493.1253(b)(1) Each laboratory that introduces an unmodified, FDA-cleared or approved test system must do the following before reporting patient test results: (1)(i) Demonstrate that it can obtain performance specifications comparable to those established by the manufacturer for the following performance characteristics: (1)(i)(A) Accuracy. (1)(i) (B) Precision. (1)(i)(C) Reportable range of test results for the test system. (1)(ii) Verify that the manufacturer's reference intervals (normal values) are appropriate for the laboratory's patient population. This STANDARD is not met as evidenced by: Based on a review of the laboratory's verification records, the laboratory's reference ranges, and staff interview, it was revealed that the laboratory failed to have documentation of verifying 3 of 3 patient normal ranges for Complete Blood Count (CBC) testing on the Drew Scientific D3 hematology analyzer. Findings include: 1. A review of the laboratory's verification records for the Drew Scientific D3 hematology analyzer revealed verification studies were performed in October 2021. 2. Further review of the laboratory's verification records revealed the laboratory failed to have documentation of verifying the following 3 patient normal ranges for CBC testing on the Drew Scientific D3 hematology analyzer: a) Pediatric (age 0-2 years): WBC 6.0 - 14.0 LYM# 1.8 - 6.6 MID# 0.1 - 1.0 GRA# 1.1 - 8.0 LYM% 25.0 - 50.0 MID% 2.0 - 10.0 GRA% 45.0 - 65.0 RBC 3.80 - 5.40 HGB 10.5 - 14.0 HCT 32.0 - 42.0 MCV 72.0 - 88.0 MCH 30.0 - 30.0 MCHC 32.0 - 36.0 RDW 11.5 - 16.0 PLT 150 - 400 MPV 6.0 - 9.5 b) Pediatric (age 2-18 years): WBC 4.0 - 10.5 LYM# 1.0 - 3.5 MID# 0.1 - 1.0 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 -- GRA# 1.5 - 6.6 LYM% 25.0 - 40.0 MID% 2.0 - 10.0 GRA% 45.0 - 70.0 RBC 4.20 - 5.60 HGB 12.0 - 16.0 HCT 35.0 - 47.0 MCV 78.0 - 95.0 MCH 26.0 - 32.0 MCHC 32.0 - 36.0 RDW 11.5 - 14.0 PLT 150 - 400 MPV 6.0 - 9.5 c) Adult: WBC 4.0 - 12.0 LYM# 1.0 - 5.0 MID# 0.1 - 1.0 GRA# 2.0 - 8.0 LYM% 25.0 - 50.0 MID% 2.0 - 10.0 GRA% 50.0 - 80.0 RBC 4.00 - 6.20 HGB 11.0 - 17.0 HCT 35.0 - 55.0 MCV 80.0 - 100.0 MCH 26.0 - 34.0 MCHC 31.0 - 35.5 RDW 10.0 - 16.0 PLT 150 - 400 MPV 7.0 - 11.0 3. An interview with the technical consultant on 9/1/22 at 10:10 a.m. in the break room, after review of the records, confirmed the above findings. Key: WBC - white blood cell RBC - red blood cell HGB - hemoglobin HCT - hematocrit MCV - mean corpuscular volume MCH - mean corpuscular hemoglobin MCHC - mean corpuscular hemoglobin concentration RDW- red cell distribution width PLT - platelet MPV - mean platelet volume LYM - lymphocytes MID - monocytes, basophils, eosinophils GRAN - granulocytes -- 2 of 2 --

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Survey - December 5, 2018

Survey Type: Standard

Survey Event ID: VWNP11

Deficiency Tags: D0000 D2121 D2122 D2128 D6054 D0000 D2121 D2122 D2128 D6054

Summary:

Summary Statement of Deficiencies D0000 Noted deficiencies and plans of correction were discussed with the laboratory representatives at the entrance and exit conferences. The facility representatives were given an opportunity to provide evidence of compliance with the noted deficiencies, and no such evidence was provided prior to survey exit. The facility was found to be in compliance with applicable Conditions of Participation in the CLIA program, and recertification is recommended. Note: The CMS-2567 (Statement of Deficiencies) is an official, legal document. All information must remain unchanged except for entering the

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