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
522521 Mukwonago Dialysis Center 400 Bayview Rd Suite F Mukwonago WI 5 (Chicago) 04/17/2019 E8WP11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0229 Mixing Systems - Permanent Record/Verification Testing Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0632 Qapi Indicator - Anemia Management Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
522521 Mukwonago Dialysis Center 400 Bayview Rd Suite F Mukwonago WI 5 (Chicago) 01/26/2023 I11E11 Complaint, 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
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
522521 Mukwonago Dialysis Center 400 Bayview Rd Suite F Mukwonago WI 5 (Chicago) 07/31/2024 DGDO11 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
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
522523 Menomonee Falls Dialysis N87 W17301 Main St Menomonee Falls WI 5 (Chicago) 06/04/2019 W0HT11 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
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0119 Ic - Supply Cart Distant/No Supplies In Pockets Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0466 Informed - External Grievance Processes Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0543 Manage Volume Status Standard
V0547 Manage Anemia/H/H Measured Monthly Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0554 Transplantation Status Plan Or Why Not Standard
V0629 Qapi Indicator - Adequacy Of Dialysis Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0713 Md Resp - Staff Ed, Training & Performance Standard
522523 Menomonee Falls Dialysis N87 W17301 Main St Menomonee Falls WI 5 (Chicago) 02/23/2023 JFWP11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
522524 Fmc Midwest Good Hope 7701 W Clinton Ave Milwaukee WI 5 (Chicago) 02/11/2019 YFO211 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0502 Assess Current Health Status Inc Comorbids Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
522524 Fmc Midwest Good Hope 7701 W Clinton Ave Milwaukee WI 5 (Chicago) 09/28/2022 1HT311 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0039 Ep Testing Requirements Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0120 Ic - Transducer Protectors: Not Wetted/Changed Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0800 Covid-19 Vaccination Of Facility Staff Standard
522525 Watertown Dialysis Center 1905 Market Way Watertown WI 5 (Chicago) 04/02/2019 3F0411 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0502 Assess Current Health Status Inc Comorbids Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0543 Manage Volume Status Standard
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0561 Track Tp Referrals/Communicate With Tp Ctr Annually & If D Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0633 Qapi Indicator - Vascular Access Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
522525 Watertown Dialysis Center 1905 Market Way Watertown WI 5 (Chicago) 10/15/2019 N73M11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
E0039 Ep Testing Requirements Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0132 Ic - Training And Education Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0232 Bicarb Mixing Sys - Empty/Disinfect/Prevent Corrosion Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
522525 Watertown Dialysis Center 1905 Market Way Watertown WI 5 (Chicago) 11/09/2021 XKEN11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0028 Dialysis Emergency Equipment Standard
E0038 Esrd Ep Training Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area 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
V0260 Personnel - Training Program/Periodic Audits Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0507 Assess Anemia Standard
V0543 Manage Volume Status Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0713 Md Resp - Staff Ed, Training & Performance Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard