Upper Cumberland Cancer Care

CLIA Laboratory Citation Details

2
Total Citations
5
Total Deficiencyies
5
Unique D-Tags
CMS Certification Number 44D1064042
Address 707 S Main Street, Crossville, TN, 38555
City Crossville
State TN
Zip Code38555
Phone931 456-8435
Lab DirectorMARK HENDRIXSON

Citation History (2 surveys)

Survey - June 21, 2023

Survey Type: Standard

Survey Event ID: NO5N11

Deficiency Tags: D2007 D5403 D5209

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 review of the laboratory's American Proficiency Institute (API) proficiency testing (PT) records, the Centers for Medicare and Medicaid Services form 209 Laboratory Personnel Report (CMS-209) and interview with the laboratory's lead testing person (TP#1), the laboratory failed to test proficiency testing samples by routine testing personnel in 2021 and 2022. The finding include: 1. Review of the laboratory's PT records revealed that testing personnel number two and three did not participate in six of six Hematology PT events (2021 events one, two, and three; 2022 events one, two, and three). 2. Review of the CMS-209 revealed four personnel who perform patient testing. 3. Interview with the laboratory's lead testing person (TP#1) at approximately 11:30 am on June 21, 2023 confirmed that testing personnel number two and three did not participate in six of six Hematology PT events, resulting in the laboratory failing to test proficiency testing samples by the same personnel who perform patient testing in 2021 and 2022. D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES CFR(s): 493.1235 As specified in the personnel requirements in subpart M, the laboratory must establish and follow written policies and procedures to assess employee and, if applicable, consultant competency. 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 -- This STANDARD is not met as evidenced by: Based on review of the Centers for Medicare and Medicaid Services form 209 Laboratory Personnel Report (CMS-209), the laboratory's policies, the testing personnel (TP) records, and interview with the laboratory's lead testing person (TP#1), the laboratory failed to follow their policy for personnel competency assessment for four of four testing personnel in 2021 and 2022. The findings include: 1. Review of CMS 209 report revealed four testing personnel performing moderately complex patient testing for complete blood counts (CBCs). 2. Review of the laboratory's "Competency Verification Policy" stated, "Each year an annual evaluation form will be completed per employee (employees that perform lab testing only). This form will be placed in the employee file." 3. Review of testing personnel competency assessments revealed no annual competency assessments for testing personnel one, two, three in 2021 and 2022 and no annual competency assessment for testing personnel four in 2022. 4. Interview with the laboratory's lead testing person (TP#1) at approximately 11:30 am on 06.21.2023 confirmed the laboratory failed to follow their policy for personnel competency assessment in 2021 and 2022. 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 - September 21, 2020

Survey Type: Special

Survey Event ID: MIHO11

Deficiency Tags: D2127 D2016

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: The laboratory failed to maintain satisfactory proficiency testing (PT) performance in two out of three testing events for the Complete Blood Count (CBC) test in the Hematology specialty resulting in the 1st unsuccessful PT occurrence in 2020. (Refer to D2127) D2127 HEMATOLOGY CFR(s): 493.851(d) Failure to return proficiency testing results to the proficiency testing program within 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 -- the time frame specified by the program is unsatisfactory performance and results in a score of 0 for the testing event. This STANDARD is not met as evidenced by: Based on review of the Centers for Medicare and Medicaid Services Casper report 155 (CMS 155) and American Proficiency Institute (API) performance summary report, the laboratory failed to participate in the 3rd event 2019 and the 2nd event 2020 for the Complete Blood Count (CBC) test for the Hematology specialty resulting in the1st unsuccessful PT occurrence in 2020. 1. Review of the CMS 155 report revealed a score of 0% for the 3rd event 2019 and a score of 0% for the 2nd event 2020 for the CBC test for the Hematology specialty. 2. Review of the API performance summary report revealed 'Failure to Participate' for the 3rd event 2019 and 2nd event 2020 for CBC test resulting in a score of 0% for the Hematology specialty. -- 2 of 2 --

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