S&C QCOR Hospital 2567s
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Hospital 2567s
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Time Interval

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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 Hospital 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 Hospital Subtype Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 05/03/2024 8VCF11 Complaint
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
A0145 Patient Rights: Free From Abuse/Harassment Standard
A0386 Organization Of Nursing Services Standard
A0395 Rn Supervision Of Nursing Care Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 06/03/2022 9V7W11 Complaint
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
A0438 Form And Retention Of Records Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 03/30/2022 W8N111 Complaint
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
A0749 Infection Control Program Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 06/30/2021 GMOL11 Complaint, Special
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
A0385 Nursing Services Condition
A0144 Patient Rights: Care In Safe Setting Standard
A0395 Rn Supervision Of Nursing Care Standard
A0749 Infection Control Program Standard
A0775 Ic Professional Training Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 01/31/2019 QVEW11 Standard
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
B0000 Initial Comments - Not A Deficiency Citation Memo
A0043 Governing Body Condition
A0385 Nursing Services Condition
A0700 Physical Environment Condition
A0131 Patient Rights: Informed Consent Standard
A0144 Patient Rights: Care In Safe Setting Standard
A0392 Staffing And Delivery Of Care Standard
A0396 Nursing Care Plan Standard
A0405 Administration Of Drugs Standard
A0621 Qualified Dietitian Standard
A0622 Competent Dietary Staff Standard
A0709 Life Safety From Fire Standard
A0749 Infection Control Program Standard
A0820 Implementation Of A Discharge Plan Standard
A0886 Opo Agreement Standard
B0117 Evaluation Includes Inventory Of Assets Standard
B0118 Individual Comprehensive Treatment Plan Standard
B0121 Plan Includes Short Term/Long Range Goals Standard
B0122 Plan Includes Specific Treatment Modalities Utilized Standard
B0144 Monitor/Evaluate Quality/Appropriateness Of Services Standard
B0148 Participates In Formulation Of Treatment Plans Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 01/31/2019 QVEW21 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
K0000 Initial Comments - Not A Deficiency Citation Standard
K0293 Exit Signage Standard
K0311 Vertical Openings - Enclosure Standard
K0321 Hazardous Areas - Enclosure Standard
K0341 Fire Alarm System - Installation Standard
K0343 Fire Alarm System - Notification Standard
K0347 Smoke Detection Standard
K0374 Subdivision Of Building Spaces - Smoke Barrie Standard
K0521 Hvac Standard
K0911 Electrical Systems - Other Standard
K0919 Electrical Equipment - Other Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 12/06/2018 IZ6T11 Complaint
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
A0115 Patient Rights Condition
A0385 Nursing Services Condition
A0431 Medical Record Services Condition
A0118 Patient Rights: Grievances Standard
A0119 Patient Rights: Review Of Grievances Standard
A0123 Patient Rights: Notice Of Grievance Decision Standard
A0130 Patient Rights:Participation In Care Planning Standard
A0144 Patient Rights: Care In Safe Setting Standard
A0145 Patient Rights: Free From Abuse/Harassment Standard
A0273 Data Collection & Analysis Standard
A0395 Rn Supervision Of Nursing Care Standard
A0396 Nursing Care Plan Standard
A0438 Form And Retention Of Records Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 08/10/2017 S17E11 Complaint
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
A0396 Nursing Care Plan Standard
A0843 Reassessment Of Discharge Planning Process Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 03/25/2015 L8U811 Complaint
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
C0000 Initial Comments - Not A Deficiency Citation Memo
A0749 Infection Control Program Standard
▼ 524018 Rogers Memorial Hospital Psychiatric 34700 Valley Rd Oconomowoc WI 5 (Chicago) 11/08/2012 WCR911 Complaint
Deficiency Tag Deficiency Description Tag Type
A0000 Initial Comments - Not A Deficiency Citation Memo
A0118 Patient Rights: Grievances Standard
A0123 Patient Rights: Notice Of Grievance Decision Standard
A0145 Patient Rights: Free From Abuse/Harassment Standard