Serenity Pediatrics

CLIA Laboratory Citation Details

3
Total Citations
12
Total Deficiencyies
6
Unique D-Tags
CMS Certification Number 23D2123321
Address 71 E Long Lake Road, Bloomfield Hills, MI, 48304
City Bloomfield Hills
State MI
Zip Code48304
Phone248 533-0000
Lab DirectorHANNAN ALSAHLANI

Citation History (3 surveys)

Survey - July 2, 2025

Survey Type: Standard

Survey Event ID: EBUZ11

Deficiency Tags: D5293 D5293

Summary:

Summary Statement of Deficiencies D5293 GENERAL LABORATORY SYSTEMS QUALITY ASSESSMENT CFR(s): 493.1239(b)(c) (b) The general laboratory systems quality assessment must include a review of the effectiveness of

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Survey - October 26, 2021

Survey Type: Standard

Survey Event ID: VUHK11

Deficiency Tags: D3011 D5801 D3011 D5801

Summary:

Summary Statement of Deficiencies 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 Technical Consultant (TC), the laboratory failed to store laboratory products in a designated refrigerator for 1 day (October 26, 2021) of 1 day of storing laboratory reagents, proficiency testing specimens, and quality control material. Findings include: 1. During a tour of the laboratory on 10/26/2021 at 11:51 am, the TC showed the surveyor an overflow refrigerator in the employee break room that housed the following laboratory products in their own drawer with their own VWR thermometer: a. BxH500 Series controls - level low, normal, and high (lot 352112911, 36211292, and 372112913) expiration date of 12/05/2021 b. College of American Pathologist (CAP) proficiency testing specimens FH16 specimens #11-#15 c. McKesson True Metrix Levels 1 (1BC1A50), Level 2 (13C2A54), and Level 3 13C3A46) expiration dates of 5/31/2023 d. Beckman Coulter DxH500 series Calibrators lot 492114400 expiration date 11/05/2021 e. Consult liquid Urine Controls lot UCD0100002 expiration date 9/26/2022 f. Abbott Cholesterol LDX multianalyte control lot 902941212 expiration date 8/18/2022 g. Consult hCG Urine Control lot KN00259 expiration date 7/31/2023 and lot KN00272 expiration date 10/31/2023 2. When queried on 10/26/21 at 11:51 the TC stated the AccuVux was just restocked with vaccines so they had to move the laboratory products to another refrigerator. 3. An interview on 10/26/2021 at 11:51 am, the TC confirmed the laboratory products had been moved over to the break room refrigerator for one day due to lack of storage space. D5801 TEST REPORT 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 -- CFR(s): 493.1291(a) The laboratory must have an adequate manual or electronic system(s) in place to ensure test results and other patient-specific data are accurately and reliably sent from the point of data entry (whether interfaced or entered manually) to final report destination, in a timely manner. This includes the following: (a)(1) Results reported from calculated data. (a)(2) Results and patient-specific data electronically reported to network or interfaced systems. (a)(3) Manually transcribed or electronically transmitted results and patient-specific information reported directly or upon receipt from outside referral laboratories, satellite or point-of-care testing locations. This STANDARD is not met as evidenced by: . Based on record review and interview with the Technical Consultant (TC), the laboratory failed to ensure test results were accurately entered into the laboratory information system (LIS) from the patients printed report from the Beckman Coulter DxH500 hematology analyzer for 2 (11040 and 16519) of 13 patient test reports reviewed. Findings include: 1. A record review of the manually transcribed results into the LIS revealed for 2 (11040 and 16519) of 13 patient test reports reviewed, the following test parameters were manually entered into the LIS system incorrectly: a. 11040 test date 12/09/2020 - Mean Corpuscular Volume (MCV) result was transcribed into the LIS system as 97 and the actual result from the Beckman Coulter DxH500 hematology analyzer print out was 92.0 b. 16519 test date 02/24/2021 - Red Blood Cell Distribution Width (RDW-SD) result was transcribed into the LIS system as 35.2 and the actual result from the Beckman Coulter DxH500 hematology analyzer print out was 35.8 2. An interview on 10/26/2021 at 1:14 pm, the TC confirmed the transcribed results in the LIS system were entered incorrectly. -- 2 of 2 --

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Survey - November 21, 2019

Survey Type: Standard

Survey Event ID: 5GXP11

Deficiency Tags: D5401 D5403 D5807 D5401 D5403 D5807

Summary:

Summary Statement of Deficiencies D5401 PROCEDURE MANUAL CFR(s): 493.1251(a) A written procedures manual for all tests, assays, and examinations performed by the laboratory must be available to, and followed by, laboratory personnel. Textbooks may supplement but not replace the laboratory's written procedures for testing or examining specimens. This STANDARD is not met as evidenced by: . Based on record review and interview with Testing Personnel #1 (TP1), the laboratory failed to establish a procedure for performing Complete Blood Counts (CBC) for 20 (March 2018 to November 2019) of 20 months reviewed. Findings include: 1. A review of the laboratory's established procedure manual revealed a lack of written procedures to perform CBC testing. 2. An interview on 11/21/19 at 10:20 am with TP1 confirmed the laboratory had not established a CBC procedure to be used by testing personnel. 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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