Us Dermatology Partners Weatherford - Martin

CLIA Laboratory Citation Details

2
Total Citations
8
Total Deficiencyies
3
Unique D-Tags
CMS Certification Number 45D2260496
Address 1709 Marin Dr Suite 100, Weatherford, TX
City Weatherford
State TX
Phone(817) 594-5880

Citation History (2 surveys)

Survey - May 14, 2025

Survey Type: Standard

Survey Event ID: 4VRP11

Deficiency Tags: D0000 D5429 D0000 D5429

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. D5429 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(a)(1) (a)(1) Maintenance as defined by the manufacturer and with at least the frequency specified by the manufacturer. This STANDARD is not met as evidenced by: Based on review of laboratory policy, cryostat maintenance logs, and confirmed in interview, the laboratory failed to perform the monthly maintenance on cryostat A for three of four months in 2025 (February through April) and four of four months in 2025 (January through April) for cryostat B. Findings included: 1. Review of "QUALITY CONTROL PROGRAM" laboratory policy revealed: "EQUIPMENT QUALITY CONTROL - CRYOSTAT ... 7. Air filter is cleaned as part of the maintenance every month 8. Thermometer check is done monthly ... 13. Every action is documented on the maintenance record form" 2. Review of cryostat maintenance logs in 2025 revealed: Monthly maintenance tasks: "Defrost & Decontaminate Empty defrosting liquid & decontaminate container Once completely dry Oil moving parts" Note: Tasks on the monthly cryostat maintenance logs were not the same as those stated in the laboratory policy. Further review of the maintenance logs revealed: Cryostat A Serial # CNX00372401EP: no monthly maintenance was documented for February, March and April 2025 Cryostat B Serial # S22070072: no monthly maintenance was documented for January, February, March, and April 2025 The laboratory failed to perform the monthly maintenance as required. 3. During an interview in the staff break room on 05/14/2025 at 11:10 a.m., the Regional Clinical Manager, after a review of records confirmed the laboratory failed to perform monthly maintenance. 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 - May 22, 2023

Survey Type: Standard

Survey Event ID: OFMD11

Deficiency Tags: D0000 D5311 D0000 D5311

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. 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 review of laboratory policy, patient test records, and confirmed in interview, the laboratory failed to ensure patient histopathology (Mohs) slides were labeled with at least 2 unique patient identifiers for 18 of 18 slides in 2022 (November random review) and 10 of 10 slides in 2023 (May random review). The findings include: 1. Review of the laboratory policy titled "Embedding, Cutting, and Cover-slipping Frozen Sections" revealed: "Procedure ... 2. The reverse slide mount method is used for embedding. Each slide will be labeled with the patient name, ,[sic] stage and piece number, slide number, and Mohs accession number. a. Mohs accession number is assigned by location and year (ex. MM22-001) b. Stages are Roman number: Examples: I, II, III, IV, V, etc c. Piece number is the number of piece(s) the surgeon divides the tissue into d. Slide number is an alphanumeric number: Examples: A- first slide, B- second slide, C- third slide, etc" An example of how to label a slide was illustrated in the policy: "Doe, J. MM22-001 1/1/22" The laboratory policy did not include labeling instructions to reliably identify patients using at least 2 unique patient identifiers to distinguish between specimens. 2. A random review of patient slides from 2022 (November) and 2023 (May) revealed 28 slides labeled with a patient last 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 -- name and first initial, Mohs accession number, piece number, slide number, and date of service. The laboratory failed to ensure patient histopathology (Mohs) slides were labeled with at least 2 unique patient identifiers. 3. During an interview on 05/222 /2023 at 10:35 a.m., the Office Manager and Regional Clinical Manager confirmed the above findings. -- 2 of 2 --

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