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
522596 Lake Hallie Dialysis 3636 E Melby St Lake Hallie WI 5 (Chicago) 04/06/2022 IUYG11 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
V0184 Environment: Secure And Restricted Standard
V0191 Softeners - Testing Hardness/Log Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
522597 Lake Country Dialysis 2301 Sun Valley Dr Suite 101 Delafield WI 5 (Chicago) 09/05/2019 WV5Y11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0726 Medical Records - Complete, Accurate, Accessible Standard
522597 Lake Country Dialysis 2301 Sun Valley Dr Suite 101 Delafield WI 5 (Chicago) 09/29/2020 O3NU11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0132 Ic - Training And Education Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0543 Manage Volume Status Standard
V0597 Provide Ordered Supplies/Equipment Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
522598 Capitol Court Dialysis 4176 N 56th St Milwaukee WI 5 (Chicago) 03/06/2018 M91M11 Complaint, 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
E0029 Development Of Communication Plan Standard
E0036 Ep Training And Testing 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
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0126 Ic - Hbv - Vaccinate Patients & Staff Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0542 Idt Develops Plan Of Care Standard
V0543 Manage Volume Status Standard
V0547 Manage Anemia/H/H Measured Monthly Standard
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
522598 Capitol Court Dialysis 4176 N 56th St Milwaukee WI 5 (Chicago) 09/29/2021 LAKZ11 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
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0249 Dialysate Proport - Match Machine Config W/Ratio In Use Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0540 Cfc: Patient Plan Of Care Condition
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
522598 Capitol Court Dialysis 4176 N 56th St Milwaukee WI 5 (Chicago) 11/15/2024 J7OM11 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
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0552 Psychosocial Counseling/Referrals/Assessment Tool Standard
522599 Fmc Hudson 1901 Ward Ave Suite 274 Hudson WI 5 (Chicago) 03/27/2018 ZDFB11 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
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0638 Continuously Monitor/Take Action/Track/Sustain Improve Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
522600 Siren Dialysis 24670 State Road 70 Suite 100 Siren WI 5 (Chicago) 07/20/2021 TMRR11 Special, 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
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0543 Manage Volume Status Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0631 Qapi Indicator - Mineral Metabolism/Bone Disease Standard
522601 Chilton Dialysis 425 Mb Lane Chilton WI 5 (Chicago) 11/28/2018 LDRY11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0119 Ic - Supply Cart Distant/No Supplies In Pockets Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0543 Manage Volume Status Standard
V0562 Patient/Family Education & Training Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
522601 Chilton Dialysis 425 Mb Lane Chilton WI 5 (Chicago) 03/09/2021 EZWK11 Special, 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
V0543 Manage Volume Status Standard