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
522563 Wautoma Dialysis 900 E Division St Wautoma WI 5 (Chicago) 06/13/2018 GSPC11 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
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0187 Environment - Schematic Diagrams/Labels Standard
V0229 Mixing Systems - Permanent Record/Verification Testing Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
522565 Milwaukee Dialysis Center 4775 N Green Bay Ave Milwaukee WI 5 (Chicago) 05/23/2018 MS2G11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0400 Cfc - Physical Environment Condition
V0401 Pe - Safe, Functional, Comfortable Environment Standard
522565 Milwaukee Dialysis Center 4775 N Green Bay Ave Milwaukee WI 5 (Chicago) 12/14/2021 UPP511 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0006 Plan Based On All Hazards Risk Assessment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
522565 Milwaukee Dialysis Center 4775 N Green Bay Ave Milwaukee WI 5 (Chicago) 10/04/2024 QXQB11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0120 Ic - Transducer Protectors: Not Wetted/Changed Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0504 Assess B/P & Fluid Management Needs Standard
522566 Bluemound Dialysis 601 North 99th St Suite 100 Wauwatosa WI 5 (Chicago) 07/19/2018 9QWG11 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
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0118 Ic - Single Use Vials Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0146 Ic - Catheters; General Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
522566 Bluemound Dialysis 601 North 99th St Suite 100 Wauwatosa WI 5 (Chicago) 10/13/2022 8KID11 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
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0184 Environment: Secure And Restricted Standard
V0504 Assess B/P & Fluid Management Needs Standard
522566 Bluemound Dialysis 601 North 99th St Suite 100 Wauwatosa WI 5 (Chicago) 02/23/2024 QC2U11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0110 Cfc - Infection Control Condition
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
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
522566 Bluemound Dialysis 601 North 99th St Suite 100 Wauwatosa WI 5 (Chicago) 07/22/2025 WU1J11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0260 Personnel - Training Program/Periodic Audits Standard
522568 Kidney Replacement Therapies 6125 Green Bay Rd Suite 100 Kenosha WI 5 (Chicago) 10/08/2019 O87Q11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0500 Cfc - Patient Assessment Condition
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0519 Frequency Reassessment - Stable - Annual Standard
V0540 Cfc: Patient Plan Of Care Condition
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0542 Idt Develops Plan Of Care Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0556 Poc Completed/Signed By Idt & Patient Standard
V0560 Patients Seen By Med Staff Member Monthly Standard
V0680 Cfc - Personnel Qualifications Condition
V0686 Charge Nurse - 12 Mo Nursing + 3 Mo Dialysis Standard
V0696 Water Treatment System Techs Training Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0713 Md Resp - Staff Ed, Training & Performance Standard
V0714 Md Resp - Develop, Review& Approve P&P Standard
V0716 Md Resp - Ensure Involuntary Discharge P&P Followed Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
V0750 Cfc - Governance Condition
V0757 Staff # & Ratio Meet Patient Needs Standard
V0760 Gb - Responsible For Staff Oriented To Facility & Resp Standard
V0765 Internal Grievance Process Components & Implemented Standard
V0766 Gb & Med Dir Ensure All Staff Follow Disch/Transfer P&P Standard
522568 Kidney Replacement Therapies 6125 Green Bay Rd Suite 100 Kenosha WI 5 (Chicago) 11/26/2019 O87Q12 Complaint
Deficiency Tag Deficiency Description Tag Type
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0119 Ic - Supply Cart Distant/No Supplies In Pockets Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0229 Mixing Systems - Permanent Record/Verification Testing Standard