Walnut Ridge Family Medical Clinic

CLIA Laboratory Citation Details

3
Total Citations
10
Total Deficiencyies
10
Unique D-Tags
CMS Certification Number 04D2127194
Address 1045 West Main Street, Suite C, Walnut Ridge, AR, 72476
City Walnut Ridge
State AR
Zip Code72476
Phone(870) 886-8300

Citation History (3 surveys)

Survey - August 27, 2025

Survey Type: Standard

Survey Event ID: OIL311

Deficiency Tags: D6031 D5209

Summary:

Summary Statement of Deficiencies 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. This STANDARD is not met as evidenced by: Based on review of the CMS 209 form, personnel records, and interview it was determined that the competency of the Technical Supervisor (TS) was not assessed by the laboratory director on an annual basis. Findings follow: A) Review of Technical Supervisor (TS) personnel files on the CMS 209 form, one of two TS personnel revealed that the annual evaluation of the competency of the TS-1 personnel was not documented annually for 2024, and 2025. B) Upon request, the laboratory was unable to provide other competency evaluations of the TS-1 personnel on the CMS 209 form, no 2024 and 2025 competency evaluation for TS-1. C) In an interview on 8/26/2025 at 12:22 p.m. Technical Consultant on the CMS 209 form said, "no other competency evaluations were present and available". D6031 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(13) (e)(13) Ensure that an approved procedure manual is available to all personnel responsible for any aspect of the testing process; and This STANDARD is not met as evidenced by: Through a review of policy and procedure manuals, lack of documentation, and interviews with laboratory staff, it was determined the current laboratory director failed to sign and date a procedure as approved. Survey findings follow: A. A policy 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 -- and procedure manual for Proficiency Testing (PT) on the Agilent Technologies 6420 Triple Quad Liquid Chromatography Mass Spectrometer (LC/GC) for high complexity testing presented without approval of the Laboratory Directory. B. In an interview on 8/27/2025 at 2:39 p.m. Technical Consultant confirmed no signature of approval for the Proficiency Testing (PT) on the Agilent Technologies 6420 Triple Quad Liquid Chromatography Mass Spectrometer (LC/GC) for high complexity testing. -- 2 of 2 --

πŸ”’ Unlock Deficiency Summary

Get full access to the detailed deficiency summary for this facility

One-time payment β€’ Lifetime access

Survey - March 14, 2025

Survey Type: Special

Survey Event ID: U7ME11

Deficiency Tags: D2016 D6000 D2107 D6016

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: Based on review of the 2024 CMS Casper Reports 096D, 0153D, and the American Proficiency Institute (API) proficiency testing results, the laboratory failed to have initial successful participation in proficiency testing for the analyte Free Thyroxine. Failure to achieve satisfactory performance for the same analyte or test in two consecutive testing events or two out of three consecutive testing events is unsuccessful performance as cited at D2107. D2107 ENDOCRINOLOGY CFR(s): 493.843(f) 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 -- (f) Failure to achieve satisfactory performance for the same analyte or test in two consecutive testing events or two out of three consecutive testing events is unsuccessful performance. This STANDARD is not met as evidenced by: Based on review of the 2024 CMS Casper Reports 096D, 0153D and API proficiency testing results, it was determined the laboratory failed to have satisfactory participation in proficiency testing for the analyte Free Thyroxine. Survey Findings follow: A. A review of the proficiency testing results revealed the laboratory received a score of 60% for the analyte Free Thyroxine in the first proficiency testing event of 2024. B. A review of the proficiency testing results revealed the laboratory received a score of 20% for the analyte Free Thyroxine in the third proficiency testing event of 2024. D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR CFR(s): 493.1403 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 2024 proficiency testing results, the laboratory director failed to ensure that the proficiency testing samples are tested as required under Subpart H of this part. Refer to D6016. D6016 LABORATORY DIRECTOR RESPONSIBILITIES CFR(s): 493.1407(e)(4)(i) (e)(4)(i) The proficiency testing samples are tested as required under Subpart H of this part; This STANDARD is not met as evidenced by: Based on review of the 2024 proficiency testing events, the laboratory director failed to ensure the laboratory successfully participated in proficiency testing for the analyte Free Thyroxine. Refer to D2107. -- 2 of 2 --

πŸ”’ Unlock Deficiency Summary

Get full access to the detailed deficiency summary for this facility

One-time payment β€’ Lifetime access

Survey - August 22, 2019

Survey Type: Standard

Survey Event ID: PH0511

Deficiency Tags: D5417 D5781 D2009 D5437

Summary:

Summary Statement of Deficiencies D2009 TESTING OF PROFICIENCY TESTING SAMPLES CFR(s): 493.801(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: Through review of proficiency testing attestation forms and interview it was determined that the laboratory director did not attest that the proficiency testing was performed in the same manner as patient testing in one of nine events reviewed and testing personnel did not sign the attestation on two of nine events reviewed. Survey findings follow: A) Review of API proficiency testing Hematology/Coagulation second event 2019 revealed the laboratory director and the testing personnel did not sign the attestation statement attesting that testing was performed in the same manner as patient testing . B) Review of API proficiency testing Microbiology second event 2019 revealed the testing personnel did not sign the attestation statement attesting that testing was performed in the same manner as patient testing . C) In an interview at approximately 04:45 PM on 8/22/19, the technical consultant, identified as number three on the CMS 209 form, confirmed that the signatures were not present on the proficiency testing event attestations identified above. 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. 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 -- This STANDARD is not met as evidenced by: Through observation made during a tour of the laboratory,interview with laboratory staff , calibration records for the Vitros chemistry analyzer and patient result reports it was determined that the laboratory had one of three boxes of Vitros Triglyceride reagents available for use after its date of expiration and expired reagents had been used to perform and report triglyceride assays on patients in July 2019 . Findings follow: 1. The laboratory had one of three boxes of expired triglyceride reagent. A) During a tour of the laboratory on 8/22/19 at approximately 04:00 PM one of three boxes of Vitros Triglyceride reagent lot number 0734-3427-6783 with expiration date of 7/6/19 was observed in the chemistry reagent storage freezer. B) In an interview on 8/22/19 at approximately 04:00 PM laboratory staff members, identified as numbers three and seven on the CMS 209 form, confirmed that the reagent identified above had expired and was available for use. 2. The laboratory used expired reagent to perform triglyceride assays on patients in July 2019. A) Review of calibration records for the Vitros chemistry analyzer revealed that Vitros Triglyceride reagents, lot number 0734-3427-6783 expiration date 7/6/19, were in use until 8/8/19. B) Review of patient result reports for the dates of 7/12/19 through 7/18/19 inclusive revealed that triglyceride assays were performed and reported on forty-nine patients. C) In an interview on 8/22/19 at approximately 4:45 PM, the laboratory staff member, identified as number three on the CMS 209 form, confirmed that the triglyceride reagent identified above expired on 7//6/19 and had been used to perform and report triglyceride assays on patients after 7/6/19 until 8/8/19. D5437 CALIBRATION AND CALIBRATION VERIFICATION CFR(s): 493.1255(a) Unless otherwise specified in this subpart, for each applicable test system the laboratory must perform and document calibration procedures-- (1) Following the manufacturer's test system instructions, using calibration materials provided or specified, and with at least the frequency recommended by the manufacturer; (2) Using the criteria verified or established by the laboratory as specified in 493.1253(b) (3)-- (2)(i) Using calibration materials appropriate for the test system and, if possible, traceable to a reference method or reference material of known value; and (2)(ii) Including the number, type, and concentration of calibration materials, as well as acceptable limits for and the frequency of calibration; and (3) Whenever calibration verification fails to meet the laboratory's acceptable limits for calibration verification. This STANDARD is not met as evidenced by: Through a review of the manufacturer's requirements, documentation of calibrations, and interview with laboratory staff, it was determined the laboratory failed to perform calibration with at least the frequency recommended by the manufacturer. Survey findings follow: A. The manufacturer of the Viitros 350 chemistry analyzer requires calibration at least every six months. B. Calibration of the Vitros 350 chemistry analyzer was documented on 10/24/18 and not again until 8/8/19 (approximately three months late). C. In an interview at approximately 4:45 PM on 8/22/19, the laboratory staff member, identified as number three on the CMS 209 form, confirmed the calibration of the Vitros 350 chemistry instrument was not performed on time. D5781

πŸ”’ Unlock Deficiency Summary

Get full access to the detailed deficiency summary for this facility

One-time payment β€’ Lifetime access