Valley Stream Professional Medical Services Llc

CLIA Laboratory Citation Details

2
Total Citations
6
Total Deficiencyies
4
Unique D-Tags
CMS Certification Number 33D2104174
Address 260 West Sunrise Highway, Suite 102, Valley Stream, NY, 11581
City Valley Stream
State NY
Zip Code11581
Phone516 830-4116
Lab DirectorJACOB WHITE

Citation History (2 surveys)

Survey - February 3, 2026

Survey Type: Standard

Survey Event ID: P65F11

Deficiency Tags: D5211 D2009 D5403

Summary:

Summary Statement of Deficiencies D2009 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(b)(1) (b)(1) The individual testing or examining the samples and the laboratory director must attest to the routine integration of the samples into the patient workload using the laboratory's routine methods. This STANDARD is not met as evidenced by: Based on review of the laboratory's Standard Operating Procedures (SOP) manual, American Proficiency Testing (API) PT (Proficiency Testing) records, as well as interview with the Office Manager (OM), the laboratory failed to document attestation of the individual testing or examining the samples to the routine integration of the samples into the patient workload using the laboratory's routine methods. FINDINGS: 1. There was no documentation of testing personnel attestation for the following PT events: a. 2024 Routine Chemistry First and Third events. b. 2025 Routine Chemistry First and Second events. 2. This is contrary to instructions included in the current, approved SOP, "Proficiency Testing Samples". 3. The OM confirmed the findings on February 3, 2026, at approximately 10:30 A.M. D5211 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(a) The laboratory must review and evaluate the results obtained on proficiency testing performed as specified in subpart H of this part. This STANDARD is not met as evidenced by: Based on review of the laboratory's SOPs, API PT summary reports, as well as interview with the OM, the laboratory failed to document review and evaluation for 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 results obtained on PT performed. FINDINGS: 1. There was no documentation of Laboratory Director (LD) review and signature for the 2024 Routine Chemistry Third event APT PT performance. 2. This is contrary to instructions included in the current, approved SOP, "Proficiency Testing Samples". 3. The OM confirmed the findings on February 3, 2026, at approximately 10:30 A.M. 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 - February 10, 2023

Survey Type: Standard

Survey Event ID: 9LJ911

Deficiency Tags: D2007 D5211 D5211

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 American Proficiency Institute (API) Proficiency Testing (PT) Chemistry records, the laboratory director and testing person failed to sign the attestation forms attesting that the PT samples were tested in the same manner as patient specimens for all events of the 2020, 2021, 2022, and 2023. Confirmed finding on an interview with office manager on 2/7/2023 about 10:30 A.M. D5211 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(a) The laboratory must review and evaluate the results obtained on proficiency testing performed as specified in subpart H of this part. This STANDARD is not met as evidenced by: Based on review of API PT reports, the laboratory failed to evaluate and document

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