Vitalogy Skincare Dba (Georgetown)

CLIA Laboratory Citation Details

3
Total Citations
18
Total Deficiencyies
8
Unique D-Tags
CMS Certification Number 45D1069391
Address 4513 Williams Drive, Georgetown, TX, 78633
City Georgetown
State TX
Zip Code78633
Phone(512) 930-3909

Citation History (3 surveys)

Survey - September 25, 2024

Survey Type: Standard

Survey Event ID: XBXZ11

Deficiency Tags: D0000 D1001 D1001 D6054 D6054

Summary:

Summary Statement of Deficiencies D0000 The laboratory was surveyed and found to be in compliance with the Conditions of the CLIA regulations found at 42 CFR 493.1 through 493.1780, and recertification is recommended. Standard level deficiencies were cited. D1001 CERTIFICATE OF WAIVER TESTS CFR(s): 493.15(e) Laboratories eligible for a certificate of waiver must-- (1) Follow manufacturers' instructions for performing the test; and (2) Meet the requirements in subpart B, Certificate of Waiver, of this part. This STANDARD is not met as evidenced by: Based on review of the manufacturer's instructions, laboratory's policy and procedure, patient testing log, presurvey paperwork, and interview, the laboratory failed to document the internal controls for the Sekisui OSOM Card Pregnancy Test for one of one testing person interviewed. Findings follow. A. Review of the Sekisui OSOM Card Pregnancy Test package insert, 2012, under Quality Control for Internal Quality Control stated, "Internal procedural controls are incorporated into each OSOM Pregnancy Test for routine quality checks. The same labeled conjugate antibody results in the appearance of both the test and the control bands. The appearance of the control band in the result window is an internal positive procedural control which validates the following: Test System: The appearance of the control band assures that the detection component of both the test line and control line is intact, that adequate sample volume was added and that adequate capillary migration of the sample has occurred. It also verifies proper assembly of the Test Device. Operator: The appearance of the control band indicates that an adequate volume of fluid was added to the sample well for capillary migration to occur. If the control band does not appear at the read time the test is invalid. The clearing of the background in the results area may be documented as a negative procedural control. It also serves as an additional capillary flow control. At the read time, the background should appear white to light 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 -- gray and not interfere with the reading of the test. The test is invalid if the background fails to clear and obscures the observation of a distinct control band." B. Review of the laboratory's policy and procedure titled Work Instructions for Performing HCG Testing, effective 05/21/2012, under 5.0 Performing HCG Test at 5.2 Interpreting Results stated "A Positive Result is: Two distinct red lines. One line should be in the control region, the other in the test region. (Refer to the illustration packaged with the HCG test). A Negative result is: One red line appears in the control region. No apparent red or pink line appears in the test region. (Refer to the illustration packaged with the HCG test). An Invalid result is: Control line fails to appear. Insufficient specimen volume or incorrect procedural techniques are the most likely reasons for control line failures. Review the procedure and repeat the test with a new test. If the problem persists discontinue use of the test kits immediately and contact technical support at (800)-637-3717 C. Review of the HCG Test Kit Quality Control/Patient Log from 06/20/2024 - 08/08/2024 showed documentation of the results for the Internal Control with Yes/No option. Review of the log showed 23 patient tests were performed from 06/20/2024 - 08/08/2024. D. Review of the CMS Form 116 showed an estimated annual test volume of 142. E. Interview with the Medical Assistant on September 25, 2024 at 1700 hours in the conference room stated she thought the control column meant external controls were performed on the box and was answering Yes for the column under Internal Control. D6054 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing at least annually, after the first year. This STANDARD is not met as evidenced by: Based on review of the laboratory's policy and procedure, competency evaluations, patient testing logs, and interview, the technical consultant failed to document the performance of individuals performing KOH (potassium hydroxide) for fungal elements at least annually for one of two KOH testing personnel for one of two years reviewed. Findings follow. A. Review of the laboratory's policy and procedure titled KOH Prep, 09/2022, under Accuracy Assessment and Competency Review stated, "This PPM test is a Moderate Complexity procedure and is required to document accuracy assessment and competency reviews at least twice a year." B. Review of competency evaluations from 2022 and 2023 for KOH for fungal elements showed none for 2023 for testing personnel #4 (as listed on the CMS Form 209). C. Review of the KOH Test Accession Logs from 2023 - 2024 revealed testing personnel #4 had reported a KOH on 06/20/2023 (K23-013) and 05/16/2024 (K24-007). D. Interview with the Clinic Manager on September 25, 2024 at 1440 hours in the conference room stated she thought the quiz was substitute for the competency evaluation. -- 2 of 2 --

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Survey - August 30, 2022

Survey Type: Standard

Survey Event ID: ERBQ11

Deficiency Tags: D0000 D0000 D5217 D6000 D6014 D6030 D5217 D6000 D6014 D6030 D6054 D6054

Summary:

Summary Statement of Deficiencies D0000 A recertification survey was performed on The laboratory was found out of compliance with the CLIA regulations. The condition not met was: D6000 - 42 C.F.R. 493.1403 Condition: Laboratories performing moderate complexity testing; laboratory director. Noted deficiencies and plans of correction were discussed with the laboratory representatives at the exit conference. D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. This STANDARD is not met as evidenced by: Based on review of accuracy assessments, patient testing logs, and interview, the laboratory failed to verify the accuracy of KOH (potassium hydroxide) for fungal elements and Scabies at least twice annually for 1 of 2 years (2 of 4 events) reviewed in 2020 and 2021. Findings follow. A. Review of accuracy assessments from 2020 and 2021 for KOH for fungal elements and Scabies showed none for 2021 (and none to date for 2022). Accuracy assessments were requested but not provided on August 30, 2022, at 1040 hours. B. Review of the KOH Test Accession Logs from 2021 - 2022 showed 17 patients were tested for fungal elements and 6 patients were tested for Scabies. C. Interview with the Clinic Manager on August 30, 2022, at 1040 hours in the conference room acknowledged accuracy assessments were done in 2020 only. Follow up interview with the Clinic Manager on August 30, 2022, at 1230 hours in the conference room confirmed there were no procedures for accuracy assessments for KOH and Scabies. D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR CFR(s): 493.1403 Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 3 -- The laboratory must have a director who meets the qualification requirements of 493. 1405 of this subpart and provides overall management and direction in accordance with 493.1407 of this subpart. This CONDITION is not met as evidenced by: Based on review of accuracy assessments, competency evaluations, patient testing logs, and interview the laboratory director failed to provide overall management and direction of the laboratory (see D6014 and D6030). D6014 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(3)(iii) The laboratory director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, and record and report test results promptly, accurate, and proficiently and for assuring compliance with the applicable regulations. (e) The laboratory director must-- (e)(3) Ensure that-- (e)(3)(iii) Laboratory personnel are performing the test methods as required for accurate and reliable results. This STANDARD is not met as evidenced by: Based on review of accuracy assessments, patient testing logs, and interview, the Laboratory Director failed to ensure accuracy assessments of KOH (potassium hydroxide) for fungal elements and Scabies were performed at least twice annually for 1 of 2 years (2 of 4 events) reviewed in 2020 and 2021 (see D5217). D6030 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(12) The laboratory director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, and record and report test results promptly, accurate, and proficiently and for assuring compliance with the applicable regulations. (e) The laboratory director must-- (e)(12) Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to assure that they are competent and maintain their competency to process specimens, perform test procedures and report test results promptly and proficiently, and whenever necessary, identify needs for remedial training or continuing education to improve skills; This STANDARD is not met as evidenced by: Based on review of competency evaluations, patient testing logs, and interview, the Laboratory Director failed to ensure competency evaluations were performed for individuals performing KOH (potassium hydroxide) for fungal elements and Scabies at least annually after the first year the individual tested patient specimens for three of three testing personnel for 1 of 2 years reviewed (refer to D6054). D6054 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the -- 2 of 3 -- performance of individuals responsible for moderate complexity testing at least annually, after the first year. This STANDARD is not met as evidenced by: Based on review of competency evaluations, patient testing logs, and interview, the technical consultant failed to document the performance of individuals performing KOH (potassium hydroxide) for fungal elements and Scabies at least annually after the first year the individual tested patient specimens for three of three testing personnel for 1 of 2 years reviewed. Findings follow. A. Review of competency evaluations from 2020 and 2021 for KOH for fungal elements and Scabies showed none for 2021 (and none to date in 2022). Competency evaluations were requested but not provided on August 30, 2022, at 1015 hours. B. Review of the KOH Test Accession Logs from 2021 - 2022 showed 17 patients were tested for fungal elements and 6 patients were tested for Scabies. C. Interview with the Clinic Manager on August 30, 2022 at 1015 hours in the conference room acknowledged competency evaluations were done in 2020 only. Follow up interview with the Clinic Manager on August 30, 2022, at 1230 hours in the conference room confirmed there were no procedures for competency evaluations for KOH and Scabies. -- 3 of 3 --

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Survey - November 2, 2018

Survey Type: Standard

Survey Event ID: 0QTK11

Deficiency Tags: D3037

Summary:

Summary Statement of Deficiencies D3037 RETENTION REQUIREMENTS CFR(s): 493.1105(a)(4) Proficiency testing records. Retain all proficiency testing records for at least 2 years. This STANDARD is not met as evidenced by: Based on a review of Medical Laboratory Evaluation proficiency testing records from 2017 and 2018 and interview with facility personnel, the laboratory failed to retain all proficiency testing records for at least 2 years in 2 of 2 reviewed events. The findings included: 1. Proficiency testing (PT) records include all information regarding the PT event including testing records, signed attestation statements, PT results and scores from the provider, documentation of review and records of any

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