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
162514 Creston Dialysis 1700 West Townline Road Suite 2 B Creston IA 7 (Kansas City) 09/15/2021 TPJV11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0142 Ic - Oversight: Monitor Activities & Implement Policies 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
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0502 Assess Current Health Status Inc Comorbids Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0562 Patient/Family Education & Training Standard
162514 Creston Dialysis 1700 West Townline Road Suite 2 B Creston IA 7 (Kansas City) 02/13/2025 A6SI11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0036 Ep Training And Testing Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
162515 Siouxland Dialysis 2530 Glenn Ave Sioux City IA 7 (Kansas City) 06/28/2018 TLFH11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0009 Local, State, Tribal Collaboration Process Standard
E0018 Procedures For Tracking Of Staff And Patients Standard
E0039 Ep Testing Requirements Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0110 Cfc - Infection Control Condition
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
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0130 Ic - Hbv - Isolation Of Machines/Equipment/Supplies Standard
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity 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
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
162515 Siouxland Dialysis 2530 Glenn Ave Sioux City IA 7 (Kansas City) 03/22/2022 NU9B11 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
V0114 Ic - Sinks Available Standard
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
162515 Siouxland Dialysis 2530 Glenn Ave Sioux City IA 7 (Kansas City) 04/25/2023 NLVE11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0228 Mixing Systems - Labeling Standard
V0502 Assess Current Health Status Inc Comorbids Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
162515 Siouxland Dialysis 2530 Glenn Ave Sioux City IA 7 (Kansas City) 03/26/2024 FJ8311 Complaint, 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
V0175 Cfc - Water And Dialysate Quality Condition
V0219 Bacterial Control - Disinfect Monthly/Disinfection Dwell Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0276 I-C Use Of Preconfigured Hd Systems - Follow Fda Labeling Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
162515 Siouxland Dialysis 2530 Glenn Ave Sioux City IA 7 (Kansas City) 07/10/2025 08KS11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0544 Achieve Adequate Clearance Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
162515 Siouxland Dialysis 2530 Glenn Ave Sioux City IA 7 (Kansas City) 11/17/2025 HSM711 Complaint
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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0128 Ic - Hbv - Isolation (Existing Facility) Standard
V0130 Ic - Hbv - Isolation Of Machines/Equipment/Supplies Standard
V0131 Ic - Hbv - Isolation - Staffing Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0145 Ic - Report Communicable Diseases Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0544 Achieve Adequate Clearance Standard
162516 Cedar Valley Dialysis Center 1661 West Ridgeway Avenue Waterloo IA 7 (Kansas City) 10/10/2019 PDHH11 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0039 Ep Testing Requirements Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0450 Cfc - Patients' Rights Condition
V0452 Respect & Dignity Standard
V0463 Receive Services Outlined In Poc Standard
V0467 Informed - Right To File Int/Ext Grievance W/O Risk/Anon 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
V0540 Cfc: Patient Plan Of Care Condition
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0543 Manage Volume Status Standard
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0628 Measure, Analyze And Track Quality Indicators Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
V0639 Prioritizing Improvement Activities Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
V0765 Internal Grievance Process Components & Implemented Standard
162516 Cedar Valley Dialysis Center 1661 West Ridgeway Avenue Waterloo IA 7 (Kansas City) 05/27/2021 7RZF11 Special, 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
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0547 Manage Anemia/H/H Measured Monthly Standard
V0551 Va Monitor To Prevent Failure/Stenosis Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard