S&C QCOR ESRD 2567s
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ESRDs 2567s
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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
▼ 522568 Kidney Replacement Therapies 6125 Green Bay Rd Suite 100 Kenosha WI 5 (Chicago) 03/01/2022 HDZF11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0003 Establishment Of The Ep Program Dialysis Condition
E0028 Dialysis Emergency Equipment Standard
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
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
V0118 Ic - Single Use Vials Standard
V0121 Ic - Handling Infectious Waste Standard
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0132 Ic - Training And Education Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0148 Ic - Monitor Cath Related Bsi Rates/Surveillance Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0201 Ro - Chemical Analysis - Frequency Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0501 Patient Assessment - Interdisciplinary Team Mbrs/Resp. Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0507 Assess Anemia 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
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0556 Poc Completed/Signed By Idt & Patient Standard
V0560 Patients Seen By Med Staff Member Monthly Standard
V0587 Fac Receive/Review Self Monitoring Data Every 2 Months Standard
V0640 Immediately Correct Any Ij Issues Standard
V0680 Cfc - Personnel Qualifications Condition
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0684 Nurse Manager - 12 Mo Rn + 6 Mo Dialysis Standard
V0685 Self Care/Home Training Nurse - 12 Mo Rn + 3 Mo Modality Standard
V0686 Charge Nurse - 12 Mo Nursing + 3 Mo Dialysis Standard
V0691 Social Worker - Msw; Grandfather Only If Hired Before 1976 Standard
V0695 Pct Certified 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
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0725 Cfc - Medical Records Condition
V0729 Mr - Complete Records Promptly Standard
V0730 Mr - Centralize All Info, Each Member Of Idt Has Access Standard
V0731 Mr - Maintain Home Patient Records Standard
V0750 Cfc - Governance Condition
V0757 Staff # & Ratio Meet Patient Needs Standard
V0758 Rn, Msw, & Rd Available To Meet Patient Needs Standard
V0760 Gb - Responsible For Staff Oriented To Facility & Resp Standard
V0800 Covid-19 Vaccination Of Facility Staff Standard
▼ 522568 Kidney Replacement Therapies 6125 Green Bay Rd Suite 100 Kenosha WI 5 (Chicago) 05/24/2022 HDZF15 Standard
Deficiency Tag Deficiency Description Tag Type
V0114 Ic - Sinks Available Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0454 Privacy & Confidentiality In Treatment Standard
V0500 Cfc - Patient Assessment Condition
V0512 Eval For Self Care, Modality & Setting Standard
V0513 Transplantation Referral Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0627 Ongoing, Uses Indicators - Improved Health Outcomes Standard
V0632 Qapi Indicator - Anemia Management Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
▼ 522568 Kidney Replacement Therapies 6125 Green Bay Rd Suite 100 Kenosha WI 5 (Chicago) 05/24/2022 IRI411 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0757 Staff # & Ratio Meet Patient Needs Standard
▼ 522570 Fmc Waupaca 102 Grand Seasons Dr Suite 7 Waupaca WI 5 (Chicago) 02/26/2025 32VN11 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
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0466 Informed - External Grievance Processes Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
▼ 522571 Fmc Midwest Appleton Avenue 7795 W Appleton Ave Suite B Milwaukee WI 5 (Chicago) 04/30/2019 SNOF11 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
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0730 Mr - Centralize All Info, Each Member Of Idt Has Access Standard
▼ 522571 Fmc Midwest Appleton Avenue 7795 W Appleton Ave Suite B Milwaukee WI 5 (Chicago) 08/10/2020 RITU11 Complaint, Special
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
▼ 522571 Fmc Midwest Appleton Avenue 7795 W Appleton Ave Suite B Milwaukee WI 5 (Chicago) 04/18/2023 9ZQ911 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0038 Esrd Ep Training Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0130 Ic - Hbv - Isolation Of Machines/Equipment/Supplies Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0184 Environment: Secure And Restricted Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
▼ 522571 Fmc Midwest Appleton Avenue 7795 W Appleton Ave Suite B Milwaukee WI 5 (Chicago) 08/25/2023 8IKM11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0038 Esrd Ep Training Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0545 Effective Nutritional Status Standard
V0546 Manage Mineral Metabolism Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
▼ 522572 Monroe Clinic Dialysis 120 7th St Monroe WI 5 (Chicago) 05/31/2018 KZEQ11 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
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0127 Ic - Hbv - Test Pts/Staff Post Last Dose Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0502 Assess Current Health Status Inc Comorbids Standard
V0543 Manage Volume Status Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
V0730 Mr - Centralize All Info, Each Member Of Idt Has Access Standard
▼ 522572 Monroe Clinic Dialysis 120 7th St Monroe WI 5 (Chicago) 10/12/2022 JG0R11 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
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0121 Ic - Handling Infectious Waste Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0543 Manage Volume Status Standard
V0550 Vascular Access - Monitor/Referrals Standard