Wi Amg Plymouth Clinic

CLIA Laboratory Citation Details

1
Total Citation
1
Total Deficiency
1
Unique D-Tag
CMS Certification Number 52D0681601
Address 2600 Kiley Way, Plymouth, WI, 53073
City Plymouth
State WI
Zip Code53073
Phone(920) 449-7000

Citation History (1 survey)

Survey - April 24, 2023

Survey Type: Standard

Survey Event ID: GCGK11

Deficiency Tags: D5417

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 surveyor observation of blood collection supplies and interview with a general supervisor, staff A, the laboratory had thirteen of thirteen expired sodium citrate 2 milliliter (ml) blood collection tubes available for patient use in the specimen collection areas. Findings include: 1. Observation of blood collection supplies in two phlebotomy patient draw stations on April 24, 2023, at 2:15 PM revealed thirteen of thirteen Vacuette 2ml sodium citrate blood collection tubes Lot number A220435J had expired on April 1, 2023. 2. Interview with staff A on April 24, 2023, at 2:20 PM confirmed thirteen of thirteen 2ml sodium citrates blood collection tubes expired on April 1, 2023, and were available for use for patient testing in the specimen collection areas. 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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