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
122515 Liberty Dialysis Hawaii Llc - Kahana Dialysis Faci 4405 Lower Honoapiilani Hwy, Suite 208 Lahaina HI 9 (San Francisco) 12/13/2019 KD4Y11 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
V0504 Assess B/P & Fluid Management Needs Standard
122516 Liberty Dialysis Hawaii, Llc West Kauai Dialysis 4643-A Waimea Canyon Drive Waimea HI 9 (San Francisco) 12/20/2019 6Y7011 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
122517 Liberty Dialysis -Hawaii Llc-Molokai Dialysis 28 Kamoi Street Suite 400 Kaunakakai HI 9 (San Francisco) 02/14/2020 ZMW511 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0126 Ic - Hbv - Vaccinate Patients & Staff Standard
122518 Liberty Dialysis Hawaii-Sullivan Dialysis 2230 Liliha Street Honolulu HI 9 (San Francisco) 01/04/2019 C60511 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0465 Informed - Internal Grievance Process Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0638 Continuously Monitor/Take Action/Track/Sustain Improve Standard
V0765 Internal Grievance Process Components & Implemented Standard
122518 Liberty Dialysis Hawaii-Sullivan Dialysis 2230 Liliha Street Honolulu HI 9 (San Francisco) 12/06/2019 XSVQ11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0452 Respect & Dignity Standard
122518 Liberty Dialysis Hawaii-Sullivan Dialysis 2230 Liliha Street Honolulu HI 9 (San Francisco) 01/14/2020 SSRU11 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
V0503 Appropriateness Of Dialysis Rx Standard
122520 Kaimuki Dialysis Facility 3625 Harding Avenue Honolulu HI 9 (San Francisco) 03/19/2019 FRR911 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
V0120 Ic - Transducer Protectors: Not Wetted/Changed Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0503 Appropriateness Of Dialysis Rx Standard
122520 Kaimuki Dialysis Facility 3625 Harding Avenue Honolulu HI 9 (San Francisco) 10/25/2019 8UFF11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
122521 Us Renal Care Kapahulu Dialysis 750 Palani Avenue Honolulu HI 9 (San Francisco) 03/15/2019 CSMC21 Standard
Deficiency Tag Deficiency Description Tag Type
K0000 Initial Comments - Not A Deficiency Citation Memo
K0211 Means Of Egress - General Standard
K0271 Discharge From Exits Standard
K0293 Exit Signage Standard
K0920 Electrical Equipment - Power Cords And Extens Standard
122521 Us Renal Care Kapahulu Dialysis 750 Palani Avenue Honolulu HI 9 (San Francisco) 03/16/2019 CSMC11 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
V0128 Ic - Hbv - Isolation (Existing Facility) Standard
V0130 Ic - Hbv - Isolation Of Machines/Equipment/Supplies Standard
V0184 Environment: Secure And Restricted Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0503 Appropriateness Of Dialysis Rx Standard