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
122532 Liberty Dialysis-Hawaii Ala Moana 500 Ala Moana Blvd, Suite 7302 Honolulu HI 9 (San Francisco) 01/20/2023 XZGC21 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
K0345 Fire Alarm System - Testing And Maintenance Standard
K0353 Sprinkler System - Maintenance And Testing Standard
122533 Liberty Dialysis-Hawaii Mililani Dialysis 95-1105 Ainamakua Drive, Suite 100 Mililani HI 9 (San Francisco) 03/09/2018 XT4Z11 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
V0182 Equipment-General/Back Up Plan Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
122533 Liberty Dialysis-Hawaii Mililani Dialysis 95-1105 Ainamakua Drive, Suite 100 Mililani HI 9 (San Francisco) 06/10/2021 KN8D11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0543 Manage Volume Status Standard
V0559 Outcome Not Achieved - Adjust Poc Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
132304 Bear Lake Dialysis Center 164 South 5th Street Montpelier ID 10 (Seattle) 11/14/2019 S40611 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
V0175 Cfc - Water And Dialysate Quality Condition
V0178 Bacteriology Of Water-Maximum And Action Levels Standard
V0220 Bacterial Control - Machine Supply Line Disinfected Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0750 Cfc - Governance Condition
V0751 Identifiable Governing Body W/Full Authority/Responsibility Standard
V0760 Gb - Responsible For Staff Oriented To Facility & Resp Standard
132304 Bear Lake Dialysis Center 164 South 5th Street Montpelier ID 10 (Seattle) 07/12/2023 NG1N11 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
V0111 Ic - Sanitary Environment Standard
V0113 Ic - Wear Gloves/Hand Hygiene Standard
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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
132500 Gem State Regional Dialysis Center 2225 Teton Plaza Idaho Falls ID 10 (Seattle) 10/19/2018 0TQR11 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
V0201 Ro - Chemical Analysis - Frequency Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0540 Cfc: Patient Plan Of Care Condition
V0543 Manage Volume Status Standard
V0557 Initial Poc Implemented - 30 Days/13 Tx Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0638 Continuously Monitor/Take Action/Track/Sustain Improve Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0712 Md Resp - Qapi Program Standard
V0714 Md Resp - Develop, Review& Approve P&P Standard
132500 Gem State Regional Dialysis Center 2225 Teton Plaza Idaho Falls ID 10 (Seattle) 09/15/2022 VJPL11 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
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0713 Md Resp - Staff Ed, Training & Performance Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
132501 Nampa Dialysis Center 846 Parkcenter Way Nampa ID 10 (Seattle) 09/21/2018 XP8211 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0006 Plan Based On All Hazards Risk Assessment Standard
E0034 Information On Occupancy/Needs Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0543 Manage Volume Status Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
132501 Nampa Dialysis Center 846 Parkcenter Way Nampa ID 10 (Seattle) 07/28/2022 XKJL11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0038 Esrd Ep Training Program Standard
E0039 Ep Testing Requirements Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0453 Receive Information In An Understandable Way Standard
V0463 Receive Services Outlined In Poc Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0540 Cfc: Patient Plan Of Care Condition
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
132502 Table Rock Dialysis Center 5610 West Gage Street, Suite B Boise ID 10 (Seattle) 01/24/2018 WH7W12 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
V0450 Cfc - Patients' Rights Condition
V0452 Respect & Dignity Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0638 Continuously Monitor/Take Action/Track/Sustain Improve Standard
V0750 Cfc - Governance Condition
V0751 Identifiable Governing Body W/Full Authority/Responsibility Standard