S&C QCOR ESRD 2567s
d QCOR:  Quality, Certification and Oversight Reports.
ESRDs 2567s
Selection Criteria

Time Interval

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Note: There is currently no ESRD 2567 data available past Feb 19, 2026 due to data system migrations.

Provider Characteristics

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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
162555 River Valley Dialysis 255 West Lucas Street Marengo IA 7 (Kansas City) 06/25/2021 H9HP11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0013 Development Of Ep Policies And Procedures Standard
E0023 Policies/Procedures For Medical Documentation Standard
E0036 Ep Training And Testing Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0726 Medical Records - Complete, Accurate, Accessible Standard
162555 River Valley Dialysis 255 West Lucas Street Marengo IA 7 (Kansas City) 04/03/2023 ELJX11 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
E0028 Dialysis Emergency Equipment Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0175 Cfc - Water And Dialysate Quality Condition
V0219 Bacterial Control - Disinfect Monthly/Disinfection Dwell Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0506 Immunization/Medication History 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
V0633 Qapi Indicator - Vascular Access Standard
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0639 Prioritizing Improvement Activities Standard
162555 River Valley Dialysis 255 West Lucas Street Marengo IA 7 (Kansas City) 05/01/2024 UTPC11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
E0007 Ep Program Patient Population Standard
E0018 Procedures For Tracking Of Staff And Patients Standard
E0040 Esrd Patient Orientation Training Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0540 Cfc: Patient Plan Of Care Condition
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0543 Manage Volume Status Standard
V0544 Achieve Adequate Clearance Standard
V0547 Manage Anemia/H/H Measured Monthly Standard
V0556 Poc Completed/Signed By Idt & Patient Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0695 Pct Certified Standard
V0730 Mr - Centralize All Info, Each Member Of Idt Has Access Standard
162555 River Valley Dialysis 255 West Lucas Street Marengo IA 7 (Kansas City) 07/16/2025 WWOU11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0545 Effective Nutritional Status Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
V0630 Qapi Indicator - Nutritional Status Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
V0730 Mr - Centralize All Info, Each Member Of Idt Has Access Standard
162556 Fresenius Medical Care Cline Family Dialysis Cente 1040 N 18th Street Centerville IA 7 (Kansas City) 02/16/2021 O6FT11 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
V0147 Ic - Staff Education Re Catheters/Catheter Care Standard
162557 Ankeny Dialysis 2625 N Ankeny Blvd Ankeny IA 7 (Kansas City) 08/15/2019 TTPV11 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0500 Cfc - Patient Assessment Condition
V0503 Appropriateness Of Dialysis Rx Standard
V0505 Assess Lab Profile Standard
V0540 Cfc: Patient Plan Of Care Condition
V0541 Patient Plan Of Care - Goals - Community-Based Standards Standard
V0556 Poc Completed/Signed By Idt & Patient Standard
V0580 Cfc: Care At Home Condition
V0582 Idt Oversees Home Training Standard
V0586 Pt/Caregiver Demonstrated Comprehension Of Training Standard
V0587 Fac Receive/Review Self Monitoring Data Every 2 Months Standard
V0626 Covers Scope Of Services/Effective/Idt Involved Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0750 Cfc - Governance Condition
V0751 Identifiable Governing Body W/Full Authority/Responsibility Standard
162557 Ankeny Dialysis 2625 N Ankeny Blvd Ankeny IA 7 (Kansas City) 02/06/2020 BTSD11 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
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
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0466 Informed - External Grievance Processes Standard
V0550 Vascular Access - Monitor/Referrals Standard
V0580 Cfc: Care At Home Condition
V0587 Fac Receive/Review Self Monitoring Data Every 2 Months Standard
V0594 Preconfig Hd Sys -Testing Water/Dialysate Follow Dfu/Fda Standard
V0595 Meet Rd 52 2004 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
V0634 Qapi Indicator - Medical Injuries/Errors Standard
V0636 Qapi Indicator - Pt Satisfaction & Grievances Standard
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
162557 Ankeny Dialysis 2625 N Ankeny Blvd Ankeny IA 7 (Kansas City) 12/19/2022 3GYM11 Complaint
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0003 Establishment Of The Ep Program Dialysis Condition
E0027 Dialysis Emergency Medical System Assistance Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0450 Cfc - Patients' Rights Condition
V0463 Receive Services Outlined In Poc Standard
V0628 Measure, Analyze And Track Quality Indicators Standard
162557 Ankeny Dialysis 2625 N Ankeny Blvd Ankeny IA 7 (Kansas City) 09/07/2023 M6MB11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
162558 Five Seasons Dialysis 1002 4th Avenue Se, Suite 1 Cedar Rapids IA 7 (Kansas City) 02/18/2020 CF9P11 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
V0142 Ic - Oversight: Monitor Activities & Implement Policies Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0250 Dialysate Proportioning - Monitor Ph/Conductivity Standard
V0260 Personnel - Training Program/Periodic Audits Standard
V0470 Rights Posted With State/Nw Contact #S And Addresses Standard
V0502 Assess Current Health Status Inc Comorbids 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