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
552681 Burlingame Dialysis 1720 El Camino Real, Suite 12 Burlingame CA 9 (San Francisco) 01/28/2020 4FD511 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
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0118 Ic - Single Use Vials Standard
V0146 Ic - Catheters; General Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0506 Immunization/Medication History Standard
V0544 Achieve Adequate Clearance Standard
552681 Burlingame Dialysis 1720 El Camino Real, Suite 12 Burlingame CA 9 (San Francisco) 03/13/2020 4FD512 Standard
Deficiency Tag Deficiency Description Tag Type
V0352 Dialyzer Priming/Rinsing The Germicide Standard
V0455 Privacy & Confidentiality In Records Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
552682 San Mateo Mills Dialysis 159 Second Avenue San Mateo CA 9 (San Francisco) 12/16/2019 EGFC11 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
V0110 Cfc - Infection Control Condition
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0121 Ic - Handling Infectious Waste Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0131 Ic - Hbv - Isolation - Staffing Standard
V0132 Ic - Training And Education Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0352 Dialyzer Priming/Rinsing The Germicide Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0725 Cfc - Medical Records Condition
V0727 Mr - Protect Patient Records From Loss/Keep Confidential Standard
552682 San Mateo Mills Dialysis 159 Second Avenue San Mateo CA 9 (San Francisco) 01/30/2020 EGFC21 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process Standard
E0018 Procedures For Tracking Of Staff And Patients Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0026 Roles Under A Waiver Declared By Secretary Standard
E0031 Emergency Officials Contact Information Standard
E0039 Ep Testing Requirements Standard
K0000 Initial Comments - Not A Deficiency Citation Memo
K0293 Exit Signage Standard
K0321 Hazardous Areas - Enclosure Standard
K0345 Fire Alarm System - Testing And Maintenance Standard
K0353 Sprinkler System - Maintenance And Testing Standard
K0511 Utilities - Gas And Electric Standard
K0531 Elevators Standard
K0712 Fire Drills Standard
552683 Calvine Dialysis 8243 E Stockton Boulevard, Suite 100 Sacramento CA 9 (San Francisco) 02/01/2018 N0L411 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0503 Appropriateness Of Dialysis Rx Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
552684 Oxnard Dialysis 1900 Outlet Center Drive Oxnard CA 9 (San Francisco) 10/25/2018 ED9M11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0544 Achieve Adequate Clearance Standard
552684 Oxnard Dialysis 1900 Outlet Center Drive Oxnard CA 9 (San Francisco) 06/13/2019 OIIU11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0456 Participate In Care, Discontinue/Refuse Treatment Standard
552686 South Cerritos Dialysis 12191 226th Street Hawaiian Gardens CA 9 (San Francisco) 01/05/2018 OXB811 Standard
Deficiency Tag Deficiency Description Tag Type
E0023 Policies/Procedures For Medical Documentation 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
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0516 Frequency - Initial: 30 Days/13 Tx Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0557 Initial Poc Implemented - 30 Days/13 Tx Standard
V0558 Implement Updates Of Poc - 15 Days P Pt Assessment Standard
552688 Richmond Dialysis 4200 Macdonald Avenue, Suite A Richmond CA 9 (San Francisco) 02/18/2020 QDD111 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
552690 Us Renal Care Torrance Dialysis 20430 Hawthorne Boulevard Torrance CA 9 (San Francisco) 02/05/2019 L61P11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0455 Privacy & Confidentiality In Records Standard