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
342610 Fmc Dialysis Services Of Warren Hills Route 1 Box 480 Hwy 158 W Warrenton NC 4 (Atlanta) 12/11/2019 XDO711 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0111 Ic - Sanitary Environment Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
342610 Fmc Dialysis Services Of Warren Hills Route 1 Box 480 Hwy 158 W Warrenton NC 4 (Atlanta) 12/07/2022 QSXC11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0550 Vascular Access - Monitor/Referrals Standard
342611 Dialysis Clinic, Inc-Kings Mountain 1010 Shelby Road Kings Mountain NC 4 (Atlanta) 12/13/2019 QOSW11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0038 Esrd Ep Training Program Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0114 Ic - Sinks Available Standard
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0765 Internal Grievance Process Components & Implemented Standard
342611 Dialysis Clinic, Inc-Kings Mountain 1010 Shelby Road Kings Mountain NC 4 (Atlanta) 06/14/2023 V4R611 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
E0040 Esrd Patient Orientation Training Standard
V0000 Initial Comments - Not A Deficiency Citation Memo
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0510 Msw - Psychosocial Needs Standard
V0552 Psychosocial Counseling/Referrals/Assessment Tool Standard
342611 Dialysis Clinic, Inc-Kings Mountain 1010 Shelby Road Kings Mountain NC 4 (Atlanta) 09/11/2024 HZGZ11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0754 Adm Resp For Fiscal Operations Standard
342612 Northside Dialysis Center 500 W Hanes Mill Road Winston-Salem NC 4 (Atlanta) 06/08/2018 O3MH11 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
V0143 Ic - Aseptic Techniques For Iv Meds Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
342612 Northside Dialysis Center 500 W Hanes Mill Road Winston-Salem NC 4 (Atlanta) 06/10/2021 EU9C11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 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
V0122 Ic - Clean, Disinfect Surfaces & Equipment/Written Protocols Standard
V0226 Mixing Sys - Follow Dfu/Monitor/Pm/Log/Sanitization Standard
V0236 Additives - Labeling Spiked Jugs/Labeling If For Specific Pt Standard
V0407 Pe - Hemodialysis Patients In View During Treatments Standard
V0543 Manage Volume Status Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
342612 Northside Dialysis Center 500 W Hanes Mill Road Winston-Salem NC 4 (Atlanta) 12/29/2021 METS11 Complaint
Deficiency Tag Deficiency Description Tag Type
V0000 Initial Comments - Not A Deficiency Citation Memo
V0634 Qapi Indicator - Medical Injuries/Errors Standard
342612 Northside Dialysis Center 500 W Hanes Mill Road Winston-Salem NC 4 (Atlanta) 06/28/2024 GGSL11 Complaint, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
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
V0456 Participate In Care, Discontinue/Refuse Treatment Standard
V0771 Electronic Data Submission Required For Program Adm Standard
342613 Northwest Greensboro Kidney Center 2837 Horse Pen Creek Road Greensboro NC 4 (Atlanta) 02/22/2019 P3YH11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0117 Ic - Clean/Dirty Areas, Med Prep Area, No Common Med Carts Standard
V0456 Participate In Care, Discontinue/Refuse Treatment Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard