Stone County Medical Center

CLIA Laboratory Citation Details

6
Total Citations
13
Total Deficiencyies
11
Unique D-Tags
CMS Certification Number 04D0049984
Address 2106 East Main Street, Mountain View, AR, 72560
City Mountain View
State AR
Zip Code72560
Phone(870) 269-4361

Citation History (6 surveys)

Survey - September 30, 2025

Survey Type: Standard

Survey Event ID: XERQ11

Deficiency Tags: D5403

Summary:

Summary Statement of Deficiencies D5403 PROCEDURE MANUAL CFR(s): 493.1251(b) (b) The procedure manual must include the following when applicable to the test procedure: (b)(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. (b)(2) Microscopic examination, including the detection of inadequately prepared slides. (b)(3) Step-by- step performance of the procedure, including test calculations and interpretation of results. (b)(4) Preparation of slides, solutions, calibrators, controls, reagents, stains, and other materials used in testing. (b)(5) Calibration and calibration verification procedures. (b)(6) The reportable range for test results for the test system as established or verified in 493.1253. (b)(7) Control procedures. (b)(8)

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Survey - July 30, 2025

Survey Type: Special

Survey Event ID: N92X11

Deficiency Tags: D2096 D6016 D2016 D6000

Summary:

Summary Statement of Deficiencies 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 review of the 2025 CMS Casper Reports 0153D, and the College of American Pathologists (CAP) proficiency testing results, it was determined the laboratory failed to have initial successful participation in proficiency testing for the analyte Partial Pressure of Oxygen (pO2). Failure to achieve satisfactory performance for the same analyte or test in two consecutive testing events or two out of three consecutive testing events is unsuccessful performance as cited at D2096. D2096 ROUTINE CHEMISTRY CFR(s): 493.841(f) 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 -- (f) Failure to achieve satisfactory performance for the same analyte or test in two consecutive testing events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on review of the 2025 CMS Casper Reports 0153D and CAP proficiency testing results, it was determined the laboratory failed to have satisfactory participation in proficiency testing for the analyte pO2. Survey Findings follow: A. A review of the proficiency testing results revealed the laboratory received a score of 40% for the analyte pO2 in the first proficiency testing event of 2025. B. A review of the proficiency testing results revealed the laboratory received a score of 60% for the analyte pO2 in the second proficiency testing event of 2025. 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 review of 2025 proficiency testing results, the laboratory director failed to ensure that the proficiency testing samples are tested as required under Subpart H of this part. 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 the 2025 proficiency testing event results, the laboratory director failed to ensure the laboratory successfully participated in proficiency testing for the Chemistry test p02. Refer to D2096. -- 2 of 2 --

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Survey - February 14, 2024

Survey Type: Standard

Survey Event ID: 350R11

Deficiency Tags: D5311

Summary:

Summary Statement of Deficiencies 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 a review of the manufacturer's instruction, the laboratory's procedure manual, patient test records, and interview with staff the laboratory failed to ensure 39 of 39 patient lactate samples were centrifuged within 15 minutes of collection during November of 2023. A) A review of the manufacturer's instructions ("Flex Reagent Cartridge" from Siemens, Lactic Acid, REF DF16, rev.-2019/04/01) for the lactate analysis performed in the laboratory, instructions stated:"centrifuge within 15 minutes of collecting specimen." B) The Laboraotry's Chemistry and Main Policy manual did not contain specfic policies for lactate, but referred to "following manufacturer's instructions and/or package inserts". C) A sample of lactate patient test records from November 2023 revealed: Sample ID (1102:G00005R); Collected (Coll): 11/02 /231443 Received (Recd): 11/02/231443; Run complete (Ent): 11/021518 1102: G00006R; Coll: 11/02/23-1845 Recd: 11/02/23-1848; Ent: 11/021918 1103: G00002R; Coll: 11/03/230800 Recd: 11/03/230803; Ent: 11/03-0837 1104:G0000lR; Coll: 11/04/23-0240 Recd: 11/04/23-0241; Ent: 11/04-0306 1104:G00003R; Coll: 11 /04/23-1058 Recd: 11/04/23-1058; Ent: 11/04-1133 1105:G00003R; Coll: 11/05/23- 2135 Recd: 11/05/23-2136; Ent: 11/05-2230 1107:G00003R; Coll: 11/07/23-0843 Recd: 11/07/23-08; Ent: 11/07-0931 D) During interview, General Supervisor #1 (as listed on the CMS-209 form) confirmed that the lab "only documented collection times, received times, and report times; but not centrifuge times." 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 - February 10, 2022

Survey Type: Standard

Survey Event ID: SV8K11

Deficiency Tags: D3025 D5441

Summary:

Summary Statement of Deficiencies D3025 REQUIREMENTS FOR TRANSFUSION SERVICES CFR(s): 493.1103(d) Investigation of transfusion reactions. The facility must have procedures for preventing transfusion reactions and when necessary, promptly identify, investigate, and report blood and blood product transfusion reactions to the laboratory and, as appropriate, to Federal and State authorities. This STANDARD is not met as evidenced by: Based upon a review of the Nursing policy titled, "Administering Blood and Blood Components", a review of eight blood administration records, and interviews with staff, it was determined the facility failed to ensure transfusion reaction policies are followed. Findings follow: A. Through a review of the Nursing policy titled, "Administering Blood and Blood Components", it was determined the policy stated, "The initial vital signs and subsequent vital signs should be noted on the Blood Bank Crossmatch/Transfusion Form or Anesthesia Record. Any negative or adverse patient response to the transfusion will be made aware by the nurse to the patient's attending physician, and documented in the nurses notes or anesthesia record." B. The policy titled, "Transfusion Reaction Protocol" states steps to follow if a transfusion reaction is suspected. The first four steps listed are: 1. Stop the Blood; 2. Keep the line open with normal saline; 3. Notify the patient's attending physician or physician on call and initiate any treatment ordered.; 4. Report the suspected reaction to the Laboratory Blood Bank Immediately. The first sign or symptom of a possible transfusion reaction listed in the policy is Fever (temperature rise of 1.5 degrees - 2 degrees over the patient's beginning temperature. C. Through a review of eight patient blood administration records for patients receiving blood between September 2021 and January 2022, it was determined that one of eight patient transfusions included symptoms of possible transfusion reaction, as listed in the Transfusion Reaction Protocol. Patient #36308 received packed red blood cells (unit #W091021419944) on 11/23/2021. At 20:15 the pretransfusion patient temperature was documented as 97.6 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 -- degrees F. At 20:20 (five minutes after the transfusion started) the patient temperature was documented as 99.4 degrees F (1.8 degree rise in temperature). According to the policy a 1.5 to 2 degree rise in temperature should initiate the transfusion reaction protocol. There was no documentation that the transfusion protocol had been initiated at that time. D. In an interview at 12:50 on 2/10/2022, laboratory employee #4 (as listed on the form CMS-209) confirmed the temperature change should have initiated the transfusion reaction protocol and that there was no documentation of a transfusion reaction investigation. D5441 CONTROL PROCEDURES CFR(s): 493.1256(a)(b)(c)(g) (a) For each test system, the laboratory is responsible for having control procedures that monitor the accuracy and precision of the complete analytic process. (b) The laboratory must establish the number, type, and frequency of testing control materials using, if applicable, the performance specifications verified or established by the laboratory as specified in 493.1253(b)(3). (c) The control procedures must-- (c)(1) Detect immediate errors that occur due to test system failure, adverse environmental conditions, and operator performance. (c)(2) Monitor over time the accuracy and precision of test performance that may be influenced by changes in test system performance and environmental conditions, and variance in operator performance. (g) The laboratory must document all control procedures performed. This STANDARD is not met as evidenced by: Through a review of the quality control policy and Procalcitonin quality control documentation, lack of documentation, and interviews with laboratory staff, it was determined the laboratory failed to monitor, over time, the accuracy and precision of Procalcitonin quality control results. Survey findings include: A. A review of the policy titled, "Daily Review of Patient and Quality Control Results" revealed the policy stated, "The Quality Control is reviewed at least once per month by the Laboratory Supervisor to monitor for shifts and trends in the Quality Control." B. During a review of Procalcitonin quality control for July, October, and December 2021, it was determined the laboratory did not have quality control results in a graph format (such as Levey-Jennings graphs) in order to identify shifts or trends in Quality Control over time. Zero of three months had documentation of evaluating for shifts and trends. C. In an interview, at 12:26 on 2/10/2022, laboratory employee #4 (as listed on the form CMS-209) confirmed that the laboratory had no method for evaluating Procalcitonin quality control results for changes over time. -- 2 of 2 --

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Survey - June 12, 2019

Survey Type: Standard

Survey Event ID: SUI011

Deficiency Tags: D5403

Summary:

Summary Statement of Deficiencies 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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Survey - January 22, 2018

Survey Type: Special

Survey Event ID: 426W11

Deficiency Tags: D2173 D6092 D2016 D6076

Summary:

Summary Statement of Deficiencies 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 review of 2017 CMS Casper Reports 155D, 153D and the American Proficiency Institute(API) proficiency testing results, it was determined the Laboratory failed to have successful participation in proficiency testing for compatibility testing as evidenced by: Failure to attain a testing event score of at least 100 percent in compatibility testing is unsatisfactory performance as cited at 2173. D2173 COMPATIBILITY TESTING CFR(s): 493.863(a) 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 -- Failure to attain an overall testing event score of at least 100 percent is unsatisfactory performance. This STANDARD is not met as evidenced by: . Based on review of 2017 CMS Casper Reports 155D, 153D and the American Proficiency Institute(API) proficiency testing results, it was determined the Laboratory failed to have successful participation in two out of three proficiency testing events for compatibility testing which is unsuccessful performance as evidenced by: A. The Laboratory received a score of 80% for compatibility testing in the third proficiency testing event of 2017. B. The Laboratory received a score of 80% for compatibility testing in the second proficiency testing event of 2017. D6076 LABORATORY DIRECTOR CFR(s): 493.1441 The laboratory must have a director who meets the qualification requirements of 493. 1443 of this subpart and provides overall management and direction in accordance with 493.1445 of this subpart. This CONDITION is not met as evidenced by: . Based on a review of the 2017 proficiency testing results, it was determined the Laboratory Director failed to ensure that

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