Valley Behavioral Health

CLIA Laboratory Citation Details

2
Total Citations
6
Total Deficiencyies
3
Unique D-Tags
CMS Certification Number 46D1042850
Address 4460 South Highland Dr, Salt Lake City, UT, 84124
City Salt Lake City
State UT
Zip Code84124
Phone(800) 403-0295

Citation History (2 surveys)

Survey - August 10, 2021

Survey Type: Standard

Survey Event ID: 0ZUV11

Deficiency Tags: D5417 D5433 D5417 D5433

Summary:

Summary Statement of Deficiencies D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(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 direct observation and interview with general supervisor and technical supervisor, reagents, control materials, and calibration materials were in use past their expiration dates. The laboratory performs approximately 1.9 million chemistry tests annually. Findings include: 1. ALT reagent in fridge stated an expiration date of 8/3 /21. 2. HDL reagent in fridge stated an expiration date of 8/9/21. 3. EtG Calibrator in fridge stated an expiration date of 7/31/21. 4. Oxycodone positive control stated an expiration date of 7/28/21. 5. EMIT specialty Multi drug level 3 control stated an expiration date of 7/28/21. 7. In an interview on 8/10/21 at approximately 6:30 pm, the general supervisor and technical supervisor confirmed that reagents, control materials, and calibration materials were located in the in use section of the fridge past their expiration dates. D5433 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(b)(1) For equipment, instruments, or test systems developed in-house, commercially available and modified by the laboratory, or maintenance and function check protocols are not provided by the manufacturer, the laboratory must establish a maintenance protocol that ensures equipment, instrument, and test system performance that is necessary for accurate and reliable test results and test result reporting. The laboratory must perform and document the maintenance activities specified in paragraph (b)(1)(i) of this section. 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 document review, direct observation, and interview with the general supervisor, the laboratory did not perform and document annual calibration of thermometers. Findings include: 1. Standard operating procedure for equipment maintenance stated that thermometers will be calibrated annually using an NIST certified thermometer. 2. Review of thermometers in use in the laboratory did not show evidence of current calibration. 3. Review of equiment maintenance documentation lacked evidence of thermometer calibration in 2020 or 2021. 4. In an interview on 8/10/21 at approximately 4:00 pm, the general supervisor confirmed that thermometer calibration was not documented in 2020. -- 2 of 2 --

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Survey - January 14, 2019

Survey Type: Standard

Survey Event ID: S5RN11

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 patient test report review, direct observation, and interview with staff, the laboratory report failed to include the correct specimen for 2 of 4 tests performed, (complete blood count [CBC] and Hemoglobin A1C tests). The laboratory performed approximately 8,800 hematology tests per year. Findings include: 1. The patient test reports reviewed for patients tested on 03/12/2018, 04/20/2018, 07/19/2018, and 01/03 /2019 stated the sample was a serum specimen. 2. Direct observation of CBC testing on 01/14/2018 at approximately 9:30 A.M. the surveyor observed testing being performed using whole blood samples. 3. In an interview with the laboratory staff on 01/14/2019 at approximately 5:00 P.M. staff confirmed the test report stated all tests on the report were from serum samples. 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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