S&C QCOR ASC 2567s
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ASCs 2567s
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Time Interval

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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 ASC 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
▼ 14C0001012 Ingalls Same Day Surgery 6701 W 159th Street Tinley Park IL 5 (Chicago) 10/22/2019 ZS1821 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0293 Exit Signage Standard
K0321 Hazardous Areas - Enclosure Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
▼ 14C0001013 Belmont/Harlem Surgery Center, Llc 3101 N Harlem Avenue Chicago IL 5 (Chicago) 03/28/2023 5F4C5-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0211 Means of Egress - General Standard
K0251 Dead-End Corridors and Common Path of Travel Standard
K0281 Illumination of Means of Egress Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
▼ 14C0001013 Belmont/Harlem Surgery Center, Llc 3101 N Harlem Avenue Chicago IL 5 (Chicago) 03/22/2023 5F4C5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0240 INFECTION CONTROL Condition
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 14C0001013 Belmont/Harlem Surgery Center, Llc 3101 N Harlem Avenue Chicago IL 5 (Chicago) 02/06/2019 T1M011 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
▼ 14C0001013 Belmont/Harlem Surgery Center, Llc 3101 N Harlem Avenue Chicago IL 5 (Chicago) 02/06/2019 T1M021 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard
K0712 Fire Drills Standard
▼ 14C0001016 Ambul Surgery Ctr Dba Surgery Ctr Of Centralia 1045 East Martin Luther King Drive Centralia IL 5 (Chicago) 11/30/2022 5DF96-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 14C0001016 Ambul Surgery Ctr Dba Surgery Ctr Of Centralia 1045 East Martin Luther King Drive Centralia IL 5 (Chicago) 11/07/2018 RLL721 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0761 Maintenance, Inspection & Testing - Doors Standard
K0911 Electrical Systems - Other Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 14C0001018 Midwest Center For Day Surgery 3811 Highland Ave Downers Grove IL 5 (Chicago) 09/26/2023 60FF5-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0240 INFECTION CONTROL Condition
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 14C0001018 Midwest Center For Day Surgery 3811 Highland Ave Downers Grove IL 5 (Chicago) 09/26/2023 60FF5-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0211 Means of Egress - General Standard
K0321 Hazardous Areas - Enclosure Standard
K0341 Fire Alarm System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0521 HVAC Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0912 Electrical Systems - Receptacles Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 14C0001018 Midwest Center For Day Surgery 3811 Highland Ave Downers Grove IL 5 (Chicago) 08/28/2019 3OQD11 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0104 SAFETY FROM FIRE Standard
Q0242 INFECTION CONTROL PROGRAM Standard