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
112692 Forest Park Dialysis Center 380 Forest Parkway Forest Park GA 4 (Atlanta) 05/16/2019 TWVZ11 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
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0557 Initial Poc Implemented - 30 Days/13 Tx Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
112692 Forest Park Dialysis Center 380 Forest Parkway Forest Park GA 4 (Atlanta) 07/28/2021 CRYM11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
112692 Forest Park Dialysis Center 380 Forest Parkway Forest Park GA 4 (Atlanta) 09/19/2025 QCRK11 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0638 Continuously Monitor/Take Action/Track/Sustain Improve Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
112693 Gainesville Dialysis 2545 Flintridge Road Suite 130 Gainesville GA 4 (Atlanta) 01/11/2018 712611 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
112693 Gainesville Dialysis 2545 Flintridge Road Suite 130 Gainesville GA 4 (Atlanta) 10/13/2023 1ZFN11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0110 Cfc - Infection Control Condition
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
V0175 Cfc - Water And Dialysate Quality Condition
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0540 Cfc: Patient Plan Of Care Condition
V0556 Poc Completed/Signed By Idt & Patient Standard
V0750 Cfc - Governance Condition
112694 Fmc Douglas County 4645 Timber Ridge Rd, Ste 140 Douglasville GA 4 (Atlanta) 07/06/2018 G73X11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
112694 Fmc Douglas County 4645 Timber Ridge Rd, Ste 140 Douglasville GA 4 (Atlanta) 01/13/2020 57IZ11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0121 Ic - Handling Infectious Waste Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
112694 Fmc Douglas County 4645 Timber Ridge Rd, Ste 140 Douglasville GA 4 (Atlanta) 01/23/2020 QPA711 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0587 Fac Receive/Review Self Monitoring Data Every 2 Months Standard
112695 Northlake Dialysis 1350 Montreal Road, Ste 200 Tucker GA 4 (Atlanta) 01/31/2019 C05411 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
112695 Northlake Dialysis 1350 Montreal Road, Ste 200 Tucker GA 4 (Atlanta) 11/12/2021 7O1711 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0716 Md Resp - Ensure Involuntary Discharge P&P Followed Standard
V0750 Cfc - Governance Condition
V0767 Involuntary Discharge Process Requirements Standard