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
522312 Fresenius Kidney Care Green Bay 2670 Monroe Rd Suite 160 De Pere WI 5 (Chicago) 10/21/2021 MJMZ11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
522313 Gundersen Lutheran Renal Dialysis La Crosse 1910 South Ave, Heritage Building 2 West La Crosse WI 5 (Chicago) 02/04/2021 ZO6N11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
522313 Gundersen Lutheran Renal Dialysis La Crosse 1910 South Ave, Heritage Building 2 West La Crosse WI 5 (Chicago) 08/09/2024 IBSV11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0595 Meet Rd 52 2004 Standard
522319 Childrens Hospital Of Wi Dialysis 8915 W Connell Court Milwaukee WI 5 (Chicago) 02/13/2018 RBVK11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0042 Integrated Ep Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0519 Frequency Reassessment - Stable - Annual Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0553 Home Dialysis Plan Or Why Not Standard
V0554 Transplantation Status Plan Or Why Not Standard
V0559 Outcome Not Achieved - Adjust Poc Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0684 Nurse Manager - 12 Mo Rn + 6 Mo Dialysis Standard
522319 Childrens Hospital Of Wi Dialysis 8915 W Connell Court Milwaukee WI 5 (Chicago) 10/06/2020 JSSE11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0025 Arrangement With Other Facilities Standard
E0028 Dialysis Emergency Equipment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0114 Ic - Sinks Available Standard
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0184 Environment: Secure And Restricted Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0587 Fac Receive/Review Self Monitoring Data Every 2 Months Standard
V0597 Provide Ordered Supplies/Equipment Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0729 Mr - Complete Records Promptly Standard
522319 Childrens Hospital Of Wi Dialysis 8915 W Connell Court Milwaukee WI 5 (Chicago) 08/30/2022 WUXW11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0028 Dialysis Emergency Equipment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
522320 Rice Lake Dialysis 1700 W Stout St Rice Lake WI 5 (Chicago) 06/20/2019 J1NJ11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0003 Establishment Of The Ep Program Dialysis Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0007 Ep Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures 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
E0025 Arrangement With Other Facilities Standard
E0027 Dialysis Emergency Medical System Assistance Standard
E0028 Dialysis Emergency Equipment Standard
E0029 Development Of Communication Plan Standard
E0032 Primary/Alternate Means For Communication 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
E0040 Esrd Patient Orientation Training Standard
E0042 Integrated Ep Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0128 Ic - Hbv - Isolation (Existing Facility) Standard
V0132 Ic - Training And Education Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0543 Manage Volume Status Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0638 Continuously Monitor/Take Action/Track/Sustain Improve Standard
V0730 Mr - Centralize All Info, Each Member Of Idt Has Access Standard
522323 Fresenius Kidney Care Sheboygan 2925 Saemann Ave Sheboygan WI 5 (Chicago) 01/14/2020 5GXU11 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
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
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0184 Environment: Secure And Restricted Standard
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0684 Nurse Manager - 12 Mo Rn + 6 Mo Dialysis Standard
V0714 Md Resp - Develop, Review& Approve P&P Standard
522324 Beloit Health System 1969 W Hart Rd Beloit WI 5 (Chicago) 03/27/2019 139F11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0028 Dialysis Emergency Equipment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0540 Cfc: Patient Plan Of Care Condition
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0553 Home Dialysis Plan Or Why Not Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0729 Mr - Complete Records Promptly Standard
522324 Beloit Health System 1969 W Hart Rd Beloit WI 5 (Chicago) 11/16/2022 IOXF11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard