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
152652 Paoli Dialysis 555 West Longest Street Paoli IN 5 (Chicago) 01/07/2020 1W0912 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
V0119 Ic - Supply Cart Distant/No Supplies In Pockets Standard
152652 Paoli Dialysis 555 West Longest Street Paoli IN 5 (Chicago) 08/14/2020 FH3611 Complaint, Special
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
V0191 Softeners - Testing Hardness/Log Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
152652 Paoli Dialysis 555 West Longest Street Paoli IN 5 (Chicago) 03/02/2023 1I7R11 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0800 Covid-19 Vaccination Of Facility Staff Standard
152653 Summit City Dialysis 3233 East Coliseum Blvd Fort Wayne IN 5 (Chicago) 06/25/2018 R2MW11 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0191 Softeners - Testing Hardness/Log Standard
V0452 Respect & Dignity Standard
152653 Summit City Dialysis 3233 East Coliseum Blvd Fort Wayne IN 5 (Chicago) 01/21/2022 3RKM11 Special, 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0453 Receive Information In An Understandable Way Standard
152653 Summit City Dialysis 3233 East Coliseum Blvd Fort Wayne IN 5 (Chicago) 06/28/2024 3VF811 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0765 Internal Grievance Process Components & Implemented Standard
152653 Summit City Dialysis 3233 East Coliseum Blvd Fort Wayne IN 5 (Chicago) 06/06/2025 PIW711 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
V0114 Ic - Sinks Available Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
152654 Fresenius Medical Care Fishers 13648 Olivia Way Fishers IN 5 (Chicago) 04/11/2019 DLFH11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
E0013 Development Of Ep Policies And Procedures Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0597 Provide Ordered Supplies/Equipment Standard
152654 Fresenius Medical Care Fishers 13648 Olivia Way Fishers IN 5 (Chicago) 05/19/2023 PFSF11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0018 Procedures For Tracking Of Staff And Patients Standard
E0028 Dialysis Emergency Equipment Standard
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
V0126 Ic - Hbv - Vaccinate Patients & Staff Standard
V0127 Ic - Hbv - Test Pts/Staff Post Last Dose Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
152654 Fresenius Medical Care Fishers 13648 Olivia Way Fishers IN 5 (Chicago) 02/29/2024 074N11 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0003 Establishment Of The Ep Program Dialysis Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0028 Dialysis Emergency Equipment Standard
E0032 Primary/Alternate Means For Communication Standard
E0038 Esrd Ep Training Program Standard
E0040 Esrd Patient Orientation Training Standard
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
V0119 Ic - Supply Cart Distant/No Supplies In Pockets Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0184 Environment: Secure And Restricted Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0455 Privacy & Confidentiality In Records Standard
V0463 Receive Services Outlined In Poc Standard
V0540 Cfc: Patient Plan Of Care Condition
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0546 Manage Mineral Metabolism Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0556 Poc Completed/Signed By Idt & Patient Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0684 Nurse Manager - 12 Mo Rn + 6 Mo Dialysis 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
V0750 Cfc - Governance Condition
V0757 Staff # & Ratio Meet Patient Needs Standard
V0760 Gb - Responsible For Staff Oriented To Facility & Resp Standard