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
162314 St Anthony Regional Hospital 311 South Clark Street Carroll IA 7 (Kansas City) 09/24/2020 TP8Q11 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0501 Patient Assessment - Interdisciplinary Team Mbrs/Resp. Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
162314 St Anthony Regional Hospital 311 South Clark Street Carroll IA 7 (Kansas City) 09/28/2020 TP8Q21 Standard
Deficiency Tag Deficiency Description Tag Type
K0000 Initial Comments - Not A Deficiency Citation Memo
K0100 General Requirements - Other Standard
162314 St Anthony Regional Hospital 311 South Clark Street Carroll IA 7 (Kansas City) 11/20/2020 TP8Q12 Standard
Deficiency Tag Deficiency Description Tag Type
V0400 Cfc - Physical Environment Condition
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
162314 St Anthony Regional Hospital 311 South Clark Street Carroll IA 7 (Kansas City) 11/09/2023 NXET11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0006 Plan Based On All Hazards Risk Assessment Standard
E0025 Arrangement With Other Facilities Standard
E0028 Dialysis Emergency Equipment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0114 Ic - Sinks Available Standard
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0127 Ic - Hbv - Test Pts/Staff Post Last Dose Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0184 Environment: Secure And Restricted Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0222 Acid Bulk Storage Tanks - Safety Controls Standard
V0470 Rights Posted With State/Nw Contact #S And Addresses Standard
V0500 Cfc - Patient Assessment Condition
V0502 Assess Current Health Status Inc Comorbids Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0511 Dialysis Access Type & Maintenance Standard
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
162318 Warner Dialysis Center Spencer 1721 W 18th Street Spencer IA 7 (Kansas City) 08/30/2018 78ZC11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
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
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0119 Ic - Supply Cart Distant/No Supplies In Pockets Standard
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0187 Environment - Schematic Diagrams/Labels Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0200 Ro - Monitor/Alarm/Prevent Use Of Unsafe Water Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0252 Microbial Monitoring - Mo Water Samples/Method Standard
V0470 Rights Posted With State/Nw Contact #S And Addresses Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0543 Manage Volume Status Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0630 Qapi Indicator - Nutritional Status Standard
V0633 Qapi Indicator - Vascular Access Standard
162320 Pella Dialysis 404 Jefferson Street Pella IA 7 (Kansas City) 03/06/2018 TSGE11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0461 Informed - Own Medical Status Standard
V0470 Rights Posted With State/Nw Contact #S And Addresses Standard
162324 Wayne County Hospital Esrd 417 South East St Corydon IA 7 (Kansas City) 12/18/2019 84U111 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0028 Dialysis Emergency Equipment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0260 Personnel - Training Program/Periodic Audits Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0500 Cfc - Patient Assessment Condition
V0503 Appropriateness Of Dialysis Rx Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0630 Qapi Indicator - Nutritional Status Standard
V0632 Qapi Indicator - Anemia Management Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0639 Prioritizing Improvement Activities Standard
V0712 Md Resp - Qapi Program Standard
162324 Wayne County Hospital Esrd 417 South East St Corydon IA 7 (Kansas City) 06/19/2023 YR4O11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0006 Plan Based On All Hazards Risk Assessment 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
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0184 Environment: Secure And Restricted Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0500 Cfc - Patient Assessment Condition
V0502 Assess Current Health Status Inc Comorbids Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0516 Frequency - Initial: 30 Days/13 Tx Standard
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
162333 Mercy Dialysis-Vinton 502 North 9th Ave Vinton IA 7 (Kansas City) 01/08/2020 4XUT11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0551 Va Monitor To Prevent Failure/Stenosis Standard
162500 Tri-State Dialysis 1515 Delhi Dubuque IA 7 (Kansas City) 09/02/2021 MNE111 Special, 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
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0630 Qapi Indicator - Nutritional Status Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0639 Prioritizing Improvement Activities Standard