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
142793 Chicago Ridge Dialysis 10511 S Harlem Ave Chicago Ridge IL 5 (Chicago) 03/21/2019 BVUY11 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
142793 Chicago Ridge Dialysis 10511 S Harlem Ave Chicago Ridge IL 5 (Chicago) 09/17/2020 ZVC011 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
V0132 Ic - Training And Education Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0544 Achieve Adequate Clearance Standard
V0595 Meet Rd 52 2004 Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
142793 Chicago Ridge Dialysis 10511 S Harlem Ave Chicago Ridge IL 5 (Chicago) 11/09/2023 5KYM11 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
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0500 Cfc - Patient Assessment Condition
V0502 Assess Current Health Status Inc Comorbids Standard
V0511 Dialysis Access Type & Maintenance Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0765 Internal Grievance Process Components & Implemented Standard
142794 Medical District Home Dialysis Llc 1111 S Western Ave Chicago IL 5 (Chicago) 03/01/2019 CH7711 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0364 Qa Audits - Physical Plant/Environmental Safety Annually Standard
V0544 Achieve Adequate Clearance Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
142795 Belvidere Dialysis 1751 Henry Lucklow Lane Belvidere IL 5 (Chicago) 05/01/2019 05I511 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
V0132 Ic - Training And Education Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0542 Idt Develops Plan Of Care Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
142795 Belvidere Dialysis 1751 Henry Lucklow Lane Belvidere IL 5 (Chicago) 11/02/2022 7FM411 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
142796 Home Dialysis Services Beverly Llc 10801 S Western Ave Ste 101 Chicago IL 5 (Chicago) 05/02/2019 GW5911 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
V0507 Assess Anemia Standard
V0543 Manage Volume Status Standard
V0547 Manage Anemia/H/H Measured Monthly Standard
V0580 Cfc: Care At Home Condition
V0586 Pt/Caregiver Demonstrated Comprehension Of Training Standard
V0589 Monitor Home Adaptation,Home Visits - Poc Standard
142796 Home Dialysis Services Beverly Llc 10801 S Western Ave Ste 101 Chicago IL 5 (Chicago) 09/28/2020 977V11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0506 Immunization/Medication History Standard
V0543 Manage Volume Status Standard
V0586 Pt/Caregiver Demonstrated Comprehension Of Training Standard
142796 Home Dialysis Services Beverly Llc 10801 S Western Ave Ste 101 Chicago IL 5 (Chicago) 09/23/2021 K4JZ11 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
V0587 Fac Receive/Review Self Monitoring Data Every 2 Months Standard
142796 Home Dialysis Services Beverly Llc 10801 S Western Ave Ste 101 Chicago IL 5 (Chicago) 03/23/2023 W1DB11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0715 Md Resp - Ensure All Adhere To P&P Standard