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
122506 Lanai Community Dialysis Center 628 7th Street Lanai City HI 9 (San Francisco) 03/26/2019 84CM11 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
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
122507 Liberty Dialysis-Hawaii Llc Hilo Dialysis Facility 1384 Kinoole Street Hilo HI 9 (San Francisco) 01/22/2018 5H9D11 Standard
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0456 Participate In Care, Discontinue/Refuse Treatment Standard
V0500 Cfc - Patient Assessment Condition
V0501 Patient Assessment - Interdisciplinary Team Mbrs/Resp. Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0511 Dialysis Access Type & Maintenance Standard
V0540 Cfc: Patient Plan Of Care Condition
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0560 Patients Seen By Med Staff Member Monthly Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
V0750 Cfc - Governance Condition
V0763 Gb - Informs Medical Staff Of P&P And Qapi Program Standard
V0765 Internal Grievance Process Components & Implemented Standard
122507 Liberty Dialysis-Hawaii Llc Hilo Dialysis Facility 1384 Kinoole Street Hilo HI 9 (San Francisco) 12/03/2019 EM6411 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0115 Ic - Wear Gowns, Shields/Masks; Staff Not Eat/Drink In Tx Area Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
122507 Liberty Dialysis-Hawaii Llc Hilo Dialysis Facility 1384 Kinoole Street Hilo HI 9 (San Francisco) 09/23/2020 4V6E11 Special
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
122507 Liberty Dialysis-Hawaii Llc Hilo Dialysis Facility 1384 Kinoole Street Hilo HI 9 (San Francisco) 02/02/2024 OWQ811 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
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
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0219 Bacterial Control - Disinfect Monthly/Disinfection Dwell Standard
V0352 Dialyzer Priming/Rinsing The Germicide Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0544 Achieve Adequate Clearance Standard
V0547 Manage Anemia/H/H Measured Monthly Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
122508 U S Renal Care Kapolei Dialysis 555 Farrington Highway Kapolei HI 9 (San Francisco) 03/21/2019 V86T11 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
V0543 Manage Volume Status Standard
122508 U S Renal Care Kapolei Dialysis 555 Farrington Highway Kapolei HI 9 (San Francisco) 01/20/2023 F1I411 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
V0184 Environment: Secure And Restricted Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
122509 U S Renal Care Pearlridge Dialysis 98-1005 Moanalua Road, Spc 420 Aiea HI 9 (San Francisco) 02/09/2018 T20M11 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
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
122509 U S Renal Care Pearlridge Dialysis 98-1005 Moanalua Road, Spc 420 Aiea HI 9 (San Francisco) 02/19/2020 JX4G11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0560 Patients Seen By Med Staff Member Monthly Standard
122509 U S Renal Care Pearlridge Dialysis 98-1005 Moanalua Road, Spc 420 Aiea HI 9 (San Francisco) 09/13/2024 MJN311 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0036 Ep Training And Testing Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0121 Ic - Handling Infectious Waste Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0184 Environment: Secure And Restricted Standard
V0219 Bacterial Control - Disinfect Monthly/Disinfection Dwell Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0714 Md Resp - Develop, Review& Approve P&P Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard