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
493514 Uva Altavista Dialysis 701 5th Steet, Suite 102 Altavista VA 3 (Philadelphia) 05/16/2019 8X9111 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0543 Manage Volume Status Standard
493515 Uva Farmville Dialysis 937 South Main Street Farmville VA 3 (Philadelphia) 09/30/2020 PZ6N11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0110 Cfc - Infection Control Condition
V0112 Ic - Cdc Mmwr 2001 Standard
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0228 Mixing Systems - Labeling Standard
493516 Uva Staunton Dialysis 81 Orchard Hills Circle Suite 103 Staunton VA 3 (Philadelphia) 09/04/2020 54DV11 Special, 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
V0143 Ic - Aseptic Techniques For Iv Meds Standard
502306 Children's Hospital Esrd 4800 Sandpoint Way Ne Seattle WA 10 (Seattle) 03/08/2018 SUDS11 Standard
Deficiency Tag Deficiency Description Tag Type
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
V0127 Ic - Hbv - Test Pts/Staff Post Last Dose Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0400 Cfc - Physical Environment Condition
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0543 Manage Volume Status Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0750 Cfc - Governance Condition
502308 Peacehealth Dialysis Center 600 Broadway Longview WA 10 (Seattle) 02/12/2018 XAPT12 Standard
Deficiency Tag Deficiency Description Tag Type
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures Standard
E0018 Procedures For Tracking Of Staff And Patients Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0023 Policies/Procedures For Medical Documentation Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0025 Arrangement With Other Facilities Standard
E0026 Roles Under A Waiver Declared By Secretary Standard
E0030 Names And Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0033 Methods For Sharing Information Standard
E0034 Information On Occupancy/Needs Standard
E0036 Ep Training And Testing Standard
E0038 Esrd Ep Training Program Standard
E0039 Ep Testing Requirements Standard
E0042 Integrated Ep Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0110 Cfc - Infection Control Condition
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0121 Ic - Handling Infectious Waste Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0182 Equipment-General/Back Up Plan Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0259 Personnel - P&P Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0456 Participate In Care, Discontinue/Refuse Treatment Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0725 Cfc - Medical Records Condition
V0726 Medical Records - Complete, Accurate, Accessible Standard
V0750 Cfc - Governance Condition
502310 Tri-State Health Services 1221 Highland Clarkston WA 10 (Seattle) 06/16/2021 05J611 Special
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0101 Compliance With Fed/State/Local Laws Standard
V0112 Ic - Cdc Mmwr 2001 Standard
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
502502 Puget Sound Kidney Center- Bremerton (Cogen) 2613 Wheaton Way Bremerton WA 10 (Seattle) 08/16/2019 F3YB11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0006 Plan Based On All Hazards Risk Assessment Standard
V0110 Cfc - Infection Control Condition
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols 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
V0175 Cfc - Water And Dialysate Quality Condition
V0184 Environment: Secure And Restricted Standard
V0190 Softeners - Automatically Regenerated/Timers/Salt/Salt Level 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
V0540 Cfc: Patient Plan Of Care Condition
V0543 Manage Volume Status Standard
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0628 Measure, Analyze And Track Quality Indicators Standard
V0680 Cfc - Personnel Qualifications Condition
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0725 Cfc - Medical Records Condition
V0726 Medical Records - Complete, Accurate, Accessible Standard
V0750 Cfc - Governance Condition
502502 Puget Sound Kidney Center- Bremerton (Cogen) 2613 Wheaton Way Bremerton WA 10 (Seattle) 11/21/2019 37D811 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0638 Continuously Monitor/Take Action/Track/Sustain Improve Standard
V0640 Immediately Correct Any Ij Issues Standard
V0680 Cfc - Personnel Qualifications Condition
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0750 Cfc - Governance Condition
502502 Puget Sound Kidney Center- Bremerton (Cogen) 2613 Wheaton Way Bremerton WA 10 (Seattle) 10/22/2021 4T2911 Complaint
Deficiency Tag Deficiency Description Tag Type
E0004 Develop Ep Plan, Review And Update Annually Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0101 Compliance With Fed/State/Local Laws Standard
V0111 Ic - Sanitary Environment Standard
V0119 Ic - Supply Cart Distant/No Supplies In Pockets Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0417 Pe-Fire Safety-Life Safety Code Standard
V0501 Patient Assessment - Interdisciplinary Team Mbrs/Resp. Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0505 Assess Lab Profile Standard
V0589 Monitor Home Adaptation,Home Visits - Poc Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0750 Cfc - Governance Condition
502503 Pskc-Everett 1005 Pacific Avenue Everett WA 10 (Seattle) 06/07/2018 0WDU21 Standard
Deficiency Tag Deficiency Description Tag Type
K0000 Initial Comments - Not A Deficiency Citation Memo
K0372 Subdivision Of Building Spaces - Smoke Barrie Standard
K0712 Fire Drills Standard