S&C QCOR ESRD 2567s
d QCOR:  Quality, Certification and Oversight Reports.
ESRDs 2567s
Selection Criteria

Time Interval

Please select the calendar year or years for which you would like data.

Note: There is currently no ESRD 2567 data available past Feb 19, 2026 due to data system migrations.

Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific ESRD deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
052889 Fmc Dialysis Services Of North 145 West Victoria Street Long Beach CA 9 (San Francisco) 03/29/2019 IY0P11 Standard
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0126 Ic - Hbv - Vaccinate Patients & Staff Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
052891 Wellbound Of San Jose 1525 Meridian Avenue, Suite 101 San Jose CA 9 (San Francisco) 12/05/2018 3HND11 Standard
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0127 Ic - Hbv - Test Pts/Staff Post Last Dose Standard
V0593 Monitor Water/Dialysate Inc On Site Evaluation Standard
052892 Soledad Dialysis Center 901 Los Coches Drive Soledad CA 9 (San Francisco) 03/12/2019 2YO911 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0401 Pe - Safe, Functional, Comfortable Environment Standard
052892 Soledad Dialysis Center 901 Los Coches Drive Soledad CA 9 (San Francisco) 06/05/2019 S9RG11 Standard
Deficiency Tag Deficiency Description Tag Type
E0028 Dialysis Emergency Equipment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0126 Ic - Hbv - Vaccinate Patients & Staff Standard
V0127 Ic - Hbv - Test Pts/Staff Post Last Dose Standard
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0552 Psychosocial Counseling/Referrals/Assessment Tool Standard
V0580 Cfc: Care At Home Condition
V0586 Pt/Caregiver Demonstrated Comprehension Of Training Standard
V0589 Monitor Home Adaptation,Home Visits - Poc Standard
V0591 Home Patient Plan Of Care Dev/Updated Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0632 Qapi Indicator - Anemia Management Standard
V0633 Qapi Indicator - Vascular Access Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
052893 Temple City Dialysis Facility 9945 Lower Azusa Road Temple City CA 9 (San Francisco) 01/31/2018 X6ES11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
052893 Temple City Dialysis Facility 9945 Lower Azusa Road Temple City CA 9 (San Francisco) 02/21/2018 LQOX12 Standard
Deficiency Tag Deficiency Description Tag Type
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area null
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected null
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts null
V0147 Ic - Staff Education Re Catheters/Catheter Care null
V0250 Dialysate Proportioning - Monitor Ph/Conductivity null
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu null
V0407 Pe - Hemodialysis Patients In View During Treatments null
V0500 Cfc - Patient Assessment null
V0501 Patient Assessment - Interdisciplinary Team Mbrs/Resp. null
V0503 Appropriateness Of Dialysis Rx null
V0504 Assess B/P & Fluid Management Needs null
V0506 Immunization/Medication History null
V0516 Frequency - Initial: 30 Days/13 Tx null
V0517 F/U Reassessment - Within 3 Months Of Initial null
V0519 Frequency Reassessment - Stable - Annual null
V0520 Frequency Reassessment - Unstable - Monthly null
V0556 Poc Completed/Signed By Idt & Patient null
V0557 Initial Poc Implemented - 30 Days/13 Tx null
V0558 Implement Updates Of Poc - 15 Days P Pt Assessment null
V0675 Cfc - Laboratory Services null
V0676 Clia Labs/Meet Needs Of Patients null
V0680 Cfc - Personnel Qualifications null
V0682 Medical Director - Bc + 12 Mo Dialysis Exp null
V0726 Medical Records - Complete, Accurate, Accessible null
052894 Rai - Monroe- Indio 46-767 Monroe Street, Suite 101 Indio CA 9 (San Francisco) 02/27/2019 08II11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
052895 Lake Elsinore Dialysis 32291 Mission Trail Road, Bldg S Lake Elsinore CA 9 (San Francisco) 03/21/2019 UGHM11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0544 Achieve Adequate Clearance Standard
052896 Cerritos Dialysis 19222 Pioneer Blvd, Suite 101 Cerritos CA 9 (San Francisco) 10/09/2019 9YBT11 Standard
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0502 Assess Current Health Status Inc Comorbids Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0516 Frequency - Initial: 30 Days/13 Tx Standard
V0517 F/U Reassessment - Within 3 Months Of Initial Standard
V0519 Frequency Reassessment - Stable - Annual Standard
V0556 Poc Completed/Signed By Idt & Patient Standard
V0557 Initial Poc Implemented - 30 Days/13 Tx Standard
V0558 Implement Updates Of Poc - 15 Days P Pt Assessment Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
052897 Tustin Dialysis 2090 N Tustin Avenue Suite 100 Santa Ana CA 9 (San Francisco) 03/08/2018 OUNV11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
E0029 Development Of Communication Plan Standard
E0038 Esrd Ep Training Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0132 Ic - Training And Education Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0190 Softeners - Automatically Regenerated/Timers/Salt/Salt Level Standard
V0231 Acid Conc Mixing Sys - Empty Completely//Prevent Corrosion Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0470 Rights Posted With State/Nw Contact #S And Addresses Standard
V0587 Fac Receive/Review Self Monitoring Data Every 2 Months Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard