Tideway Dermatology

CLIA Laboratory Citation Details

2
Total Citations
8
Total Deficiencyies
4
Unique D-Tags
CMS Certification Number 21D0894223
Address 930 Revolution St, Havre De Grace, MD, 21078
City Havre De Grace
State MD
Zip Code21078
Phone(667) 296-5301

Citation History (2 surveys)

Survey - April 24, 2025

Survey Type: Standard

Survey Event ID: 9SBJ11

Deficiency Tags: D5401 D5407 D5417 D5401 D5407 D5417

Summary:

Summary Statement of Deficiencies D5401 PROCEDURE MANUAL CFR(s): 493.1251(a) (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 procedure manual review, surveyor observation, and interview with the histotechnologist (HT), the laboratory failed to follow written procedures for performing testing on patient skin and nail scrapings for fungal elements and parasites, using a potassium hydroxide (KOH) solution. Findings: 1. The procedure, "KOH Policy and Procedure" states that patient skin and nail samples should be mixed with "1-2 drops of 20% KOH." 2. During a tour of the laboratory at 10:10 AM, it was observed that the opened and in-use bottle of KOH was labeled as "Potassium Hydroxide 10%." This did not match the concentration of 20% KOH to be used as listed in the written procedure. 3. During an interview on 04/24/2025 at 11:15 AM, the HT confirmed that the concentration of KOH used for patient testing was not what was listed in the written procedure, and that testing personnel were not following the laboratory ' s procedure for KOH testing. D5407 PROCEDURE MANUAL CFR(s): 493.1251(d) (d) Procedures and changes in procedures must be approved, signed, and dated by the current laboratory director before use. This STANDARD is not met as evidenced by: 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 -- Based on procedure manual review and interview with the histotechnologist (HT), the laboratory failed to ensure that all of the laboratory ' s written procedures were approved, signed, and dated by the LD before use. Findings: 1. During a tour of the laboratory at 10:10 AM, it was observed that the clipboard containing the patient log for testing skin and nail samples with potassium hydroxide (KOH) also held three different procedures for performing KOH testing: "KOH Guidelines," "KOH Procedure," and "KOH Policy and Procedure." 2. Three of the three procedures on the KOH clipboard were not approved (signed and dated) by the laboratory director. 3. A review of the laboratory ' s approved procedure manual showed that it did not include a copy of the three KOH procedures found on the clipboard. 4. During an interview on 04/24/2025 at 11:15 AM, the HT confirmed that the three KOH procedures were not approved by the laboratory director. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) (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: Based on record review, observation, and interview with the histotechnologist (HT), the laboratory failed to ensure that histopathology stains and reagents were not used after they exceeded their expiration date. Findings: 1. The laboratory performs a slide examination of skin and nail scrapings for fungal elements and parasites, using a potassium hydroxide (KOH) solution to dissolve tissue cells and keratinized material. 2. During a tour of the laboratory at 10:10 AM it was observed that the in-use bottle of KOH (lot number 2202) had expired on 07/21/2024. 3. A review of the "KOH Log" showed that 14 patients were tested using the expired KOH reagent between 08/07 /2024 and 04/17/2025. 4. The laboratory also uses tissue marking dye, to stain patient tissue samples prior to processing for Mohs surgery. 5. During a tour of the laboratory at 11:08 AM it was observed that five of five in-use bottles of tissue marking dyes were expired: "Black" (lot number 167158, expiration date 02/28/2025), "Yellow" (lot number 166232, expiration date 02/28/2025), "Green" (lot number 168109, expiration date 03/31/2025), "Red" (lot number 168107, expiration date 02/28/2025), and "Blue" (lot number 166704, expiration date 01/31/2025). 6. During an interview on 04/24 /2025 at 11:15 AM the HT confirmed that the laboratory failed to ensure that histopathology stains and reagents were not used after they exceeded their expiration date. -- 2 of 2 --

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Survey - February 27, 2019

Survey Type: Standard

Survey Event ID: KV9Y11

Deficiency Tags: D5805 D5805

Summary:

Summary Statement of Deficiencies D5805 TEST REPORT CFR(s): 493.1291(c) The test report must indicate the following: (c)(1) For positive patient identification, either the patient's name and identification number, or a unique patient identifier and identification number. (c)(2) The name and address of the laboratory location where the test was performed. (c)(3) The test report date. (c)(4) The test performed. (c)(5) Specimen source, when appropriate. (c)(6) The test result and, if applicable, the units of measurement or interpretation, or both. (c)(7) Any information regarding the condition and disposition of specimens that do not meet the laboratory's criteria for acceptability. This STANDARD is not met as evidenced by: Based on review of patients final reports and interview with the laboratory manager, the laboratory did not ensure that the final test report listed "Tideway Dermatology, PA" which is the name listed on the CLIA certificate. Findings: 1. During the survey patient charts were pulled to review the final report with the patients test results. Review of the patients after May 2018 showed that the name listed on the final report was "Tideway Havre de Grace." 2. The manager explained that "Tideway Dermatology, PA" joined another dermatology group and was entered into their computer system as "Tideway Havre de Grace" instead of "Tideway Dermatology, PA." 3. During the exit interview on 02/27/19 at 10:45 AM the laboratory manager confirmed that the final reports in the shared computer system did not include the correct name of the laboratory performing the tests. 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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