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

Time Interval

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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
522550 Fmc Dialysis Services Of Kaukauna 2259 Progress Way Kaukauna WI 5 (Chicago) 07/31/2018 1ULJ11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
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
V0127 Ic - Hbv - Test Pts/Staff Post Last Dose Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
522550 Fmc Dialysis Services Of Kaukauna 2259 Progress Way Kaukauna WI 5 (Chicago) 09/08/2022 0OUU11 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
V0550 Vascular Access - Monitor/Referrals Standard
522550 Fmc Dialysis Services Of Kaukauna 2259 Progress Way Kaukauna WI 5 (Chicago) 01/08/2026 P8JM11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts 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
V0543 Manage Volume Status Standard
V0550 Vascular Access - Monitor/Referrals Standard
522551 Marinette Dialysis 2706 Cahill Road Suite A Marinette WI 5 (Chicago) 06/05/2018 RN7R11 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0254 Microbial Monitoring - Sample Before Disinfect Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
522551 Marinette Dialysis 2706 Cahill Road Suite A Marinette WI 5 (Chicago) 09/14/2022 EU1W11 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0550 Vascular Access - Monitor/Referrals Standard
522552 Green Bay Dialysis 1751 Deckner Ave Green Bay WI 5 (Chicago) 10/29/2019 0RCC11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0028 Dialysis Emergency Equipment Standard
E0036 Ep Training And Testing Standard
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
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0632 Qapi Indicator - Anemia Management Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
V0729 Mr - Complete Records Promptly Standard
522552 Green Bay Dialysis 1751 Deckner Ave Green Bay WI 5 (Chicago) 02/01/2023 MFA011 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
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
522554 Bay Shore Dialysis 5650 N Green Bay Ave Suite 150 Glendale WI 5 (Chicago) 04/12/2018 U8I211 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0543 Manage Volume Status Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0713 Md Resp - Staff Ed, Training & Performance Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
522554 Bay Shore Dialysis 5650 N Green Bay Ave Suite 150 Glendale WI 5 (Chicago) 08/01/2018 V61Y11 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0003 Establishment Of The Ep Program Dialysis Condition
E0025 Arrangement With Other Facilities Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0182 Equipment-General/Back Up Plan Standard
522554 Bay Shore Dialysis 5650 N Green Bay Ave Suite 150 Glendale WI 5 (Chicago) 09/18/2019 X0NT11 Complaint
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
V0126 Ic - Hbv - Vaccinate Patients & Staff Standard
V0516 Frequency - Initial: 30 Days/13 Tx Standard
V0557 Initial Poc Implemented - 30 Days/13 Tx Standard
V0558 Implement Updates Of Poc - 15 Days P Pt Assessment Standard
V0713 Md Resp - Staff Ed, Training & Performance Standard