S&C QCOR ESRD 2567s
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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
▼ 392684 Williamsport Dialysis Clinic 1660 Sycamore Road Suite B Montoursville PA 3 (Philadelphia) 08/02/2019 85U011 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
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0323 Inventory Control Standard
V0455 Privacy & Confidentiality In Records Standard
▼ 392684 Williamsport Dialysis Clinic 1660 Sycamore Road Suite B Montoursville PA 3 (Philadelphia) 08/15/2022 UBIP11 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
V0111 Ic - Sanitary Environment Standard
V0113 Ic - Wear Gloves/Hand Hygiene Standard
V0116 Ic - Items Taken To Station Disposed/Dedicated Or Disinfected Standard
V0400 Cfc - Physical Environment Condition
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0625 Cfc - Quality Assessment & Performance Improvement Condition
V0637 Qapi Indicator - Infection Control - Trend/Plan/Act Standard
V0639 Prioritizing Improvement Activities Standard
V0713 Md Resp - Staff Ed, Training & Performance Standard
V0750 Cfc - Governance Condition
V0751 Identifiable Governing Body W/Full Authority/Responsibility Standard
V0760 Gb - Responsible For Staff Oriented To Facility & Resp Standard
▼ 392684 Williamsport Dialysis Clinic 1660 Sycamore Road Suite B Montoursville PA 3 (Philadelphia) 07/31/2025 DCHM11 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
V0111 Ic - Sanitary Environment Standard
V0400 Cfc - Physical Environment Condition
V0401 Pe - Safe, Functional, Comfortable Environment Standard
V0402 Pe - Building - Constructed/Maintained To Ensure Safety Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0520 Frequency Reassessment - Unstable - Monthly Standard
V0552 Psychosocial Counseling/Referrals/Assessment Tool Standard
V0715 Md Resp - Ensure All Adhere To P&P Standard
▼ 392686 Pdi - Ebensburg 429 Manor Drive, Suite 650 Ebensburg PA 3 (Philadelphia) 02/19/2019 R2W321 Standard
Deficiency Tag Deficiency Description Tag Type
K0000 Initial Comments - Not A Deficiency Citation Memo
K0712 Fire Drills Standard
▼ 392686 Pdi - Ebensburg 429 Manor Drive, Suite 650 Ebensburg PA 3 (Philadelphia) 02/19/2019 R2W311 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0199 Ro - Meets Aami/Monitored, Recorded On Log Standard
V0544 Achieve Adequate Clearance Standard
▼ 392686 Pdi - Ebensburg 429 Manor Drive, Suite 650 Ebensburg PA 3 (Philadelphia) 04/07/2021 L87R11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0504 Assess B/P & Fluid Management Needs Standard
V0506 Immunization/Medication History Standard
▼ 392686 Pdi - Ebensburg 429 Manor Drive, Suite 650 Ebensburg PA 3 (Philadelphia) 07/25/2022 TC6X11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0179 Bacteriology Of Water-Medical Director Responsible Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0552 Psychosocial Counseling/Referrals/Assessment Tool Standard
▼ 392686 Pdi - Ebensburg 429 Manor Drive, Suite 650 Ebensburg PA 3 (Philadelphia) 10/13/2022 TC6X21 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
K0000 Initial Comments - Not A Deficiency Citation Memo
K0223 Doors With Self-Closing Devices Standard
K0353 Sprinkler System - Maintenance And Testing Standard
K0712 Fire Drills Standard
K0923 Gas Equipment - Cylinder And Container Storag Standard
▼ 392687 Pdi - Johnstown 344 Budfield Street Johnstown PA 3 (Philadelphia) 04/10/2018 CJEX12 Standard
Deficiency Tag Deficiency Description Tag Type
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0403 Pe - Equipment Maintenance - Manufacturer'S Dfu Standard
V0410 Patient Care Staff - Current Cpr Certification Standard
V0681 Staff Licensed As Req/Qualified/Demonstrate Competencies Standard
▼ 392687 Pdi - Johnstown 344 Budfield Street Johnstown PA 3 (Philadelphia) 10/28/2020 EJY911 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
V0000 Initial Comments - Not A Deficiency Citation Memo
V0124 Ic - Hbv - Test All Pts, Review Results/Pt Status Known Preadmit Standard
V0196 Carbon Adsorption - Monitoring, Testing Frequency Standard
V0503 Appropriateness Of Dialysis Rx Standard
V0504 Assess B/P & Fluid Management Needs Standard
V0506 Immunization/Medication History Standard
V0595 Meet Rd 52 2004 Standard