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
152655 Mishawaka Dialysis 1420 Trinity Place Mishawaka IN 5 (Chicago) 11/01/2018 M5Y311 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0503 Appropriateness Of Dialysis Rx Standard
V0545 Effective Nutritional Status Standard
152655 Mishawaka Dialysis 1420 Trinity Place Mishawaka IN 5 (Chicago) 04/29/2022 5KVQ11 Complaint, 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
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
152655 Mishawaka Dialysis 1420 Trinity Place Mishawaka IN 5 (Chicago) 09/27/2022 6Z0811 Complaint
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
V0143 Ic - Aseptic Techniques For Iv Meds Standard
152655 Mishawaka Dialysis 1420 Trinity Place Mishawaka IN 5 (Chicago) 11/21/2025 QE8611 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0031 Emergency Officials Contact Information Standard
E0036 Ep Training And Testing 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
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
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0220 Bacterial Control - Machine Supply Line Disinfected 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
152656 Brownsburg Dialysis 124 East Northfield Dr Ste N Brownsburg IN 5 (Chicago) 03/24/2021 03BY11 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
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
152656 Brownsburg Dialysis 124 East Northfield Dr Ste N Brownsburg IN 5 (Chicago) 07/11/2024 9UWW11 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
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0146 Ic - Catheters; General Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0550 Vascular Access - Monitor/Referrals Standard
152657 Indiana Dialysis Company Llc 7840 Madison Avenue Indianapolis IN 5 (Chicago) 08/22/2018 KVHK11 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0003 Establishment Of The Ep Program Dialysis Condition
E0006 Plan Based On All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures Standard
E0018 Procedures For Tracking Of Staff And Patients Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0025 Arrangement With Other Facilities Standard
E0029 Development Of Communication Plan Standard
E0030 Names And Contact Information Standard
E0033 Methods For Sharing Information Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0711 Medical Director Qualified/Accountable To Governing Body Standard
V0751 Identifiable Governing Body W/Full Authority/Responsibility Standard
152657 Indiana Dialysis Company Llc 7840 Madison Avenue Indianapolis IN 5 (Chicago) 01/14/2022 7VH311 Standard
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
E0006 Plan Based On All Hazards Risk Assessment Standard
E0013 Development Of Ep Policies And Procedures Standard
E0018 Procedures For Tracking Of Staff And Patients Standard
E0028 Dialysis Emergency Equipment Standard
E0036 Ep Training And Testing Standard
E0040 Esrd Patient Orientation Training Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0110 Cfc - Infection Control Condition
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
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0225 Mixing Systems - Safe Environment/Ppe Standard
V0543 Manage Volume Status Standard
V0710 Cfc - Responsibilities Of The Medical Director Condition
V0714 Md Resp - Develop, Review& Approve P&P Standard
V0727 Mr - Protect Patient Records From Loss/Keep Confidential Standard
152657 Indiana Dialysis Company Llc 7840 Madison Avenue Indianapolis IN 5 (Chicago) 01/18/2024 X2KL11 Complaint
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
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0550 Vascular Access - Monitor/Referrals Standard
152657 Indiana Dialysis Company Llc 7840 Madison Avenue Indianapolis IN 5 (Chicago) 04/02/2024 VVLE11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0543 Manage Volume Status Standard