S&C QCOR ESRD 2567s
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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
▼ 552593 Antelope Valley Kidney Institute 43932 15th Street, Suite #103 Lancaster CA 9 (San Francisco) 08/29/2018 BLKE11 Standard
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0500 Cfc - Patient Assessment Condition
V0502 Assess Current Health Status Inc Comorbids Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0509 Rd - Nutritional Status Standard
V0510 Msw - Psychosocial Needs Standard
V0540 Cfc: Patient Plan Of Care Condition
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0543 Manage Volume Status Standard
V0552 Psychosocial Counseling/Referrals/Assessment Tool Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0639 Prioritizing Improvement Activities Standard
V0750 Cfc - Governance Condition
▼ 552593 Antelope Valley Kidney Institute 43932 15th Street, Suite #103 Lancaster CA 9 (San Francisco) 10/09/2018 BLKE12 Standard
Deficiency Tag Deficiency Description Tag Type
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
▼ 552593 Antelope Valley Kidney Institute 43932 15th Street, Suite #103 Lancaster CA 9 (San Francisco) 07/12/2021 IC2B11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0110 Cfc - Infection Control Condition
▼ 552594 Exeter Dialysis 1116 West Visalia Road, Suite 106 Exeter CA 9 (San Francisco) 05/07/2021 ES6611 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0184 Environment: Secure And Restricted Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0470 Rights Posted With State/Nw Contact #S And Addresses Standard
V0503 Appropriateness Of Dialysis Rx Standard
▼ 552596 Ontario Dialysis Center, Inc 1001 West 6th Street Ontario CA 9 (San Francisco) 06/22/2018 WXDR11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0507 Assess Anemia Standard
▼ 552596 Ontario Dialysis Center, Inc 1001 West 6th Street Ontario CA 9 (San Francisco) 05/04/2022 TVWI11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0504 Assess B/P & Fluid Management Needs Standard
▼ 552599 Moreno Valley Dialysis 22620 Goldencrest Drive, Suite 101-103 Moreno Valley CA 9 (San Francisco) 09/06/2018 QIGI11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
▼ 552599 Moreno Valley Dialysis 22620 Goldencrest Drive, Suite 101-103 Moreno Valley CA 9 (San Francisco) 02/13/2019 B30O11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0040 Esrd Patient Orientation Training Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
▼ 552601 Simi Dialysis Center Llc 1407 E Los Angeles Ave Ste G & H Simi Valley CA 9 (San Francisco) 10/17/2019 QCWL11 Standard
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0121 Ic - Handling Infectious Waste Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
▼ 552601 Simi Dialysis Center Llc 1407 E Los Angeles Ave Ste G & H Simi Valley CA 9 (San Francisco) 11/18/2020 AML611 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0504 Assess B/P & Fluid Management Needs Standard