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

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 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
14C0001018 Midwest Center For Day Surgery 3811 Highland Ave Downers Grove IL 5 (Chicago) 08/27/2019 3OQD21 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0351 Sprinkler System - Installation Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
K0374 Subdivision of Building Spaces ? Smoke Barrier Doors Standard
K0906 Gas and Vacuum Piped Systems ? Central Supply System Operations Standard
K0912 Electrical Systems - Receptacles Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
14C0001023 River Forest Surgery Center Llc 7427 W Lake St River Forest IL 5 (Chicago) 04/26/2022 Y0OG11 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
E0030 Names and Contact Information Standard
Q0104 SAFETY FROM FIRE Standard
Q0245 INFECTION CONTROL PROGRAM Standard
14C0001023 River Forest Surgery Center Llc 7427 W Lake St River Forest IL 5 (Chicago) 04/26/2022 Y0OG21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0293 Exit Signage Standard
K0321 Hazardous Areas - Enclosure Standard
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0351 Sprinkler System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0371 Subdivision of Building Spaces ? Smoke Compartments Standard
K0521 HVAC Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
14C0001023 River Forest Surgery Center Llc 7427 W Lake St River Forest IL 5 (Chicago) 03/27/2018 ZLHS11 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
Q0140 NURSING SERVICES Condition
Q0104 SAFETY FROM FIRE Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
14C0001023 River Forest Surgery Center Llc 7427 W Lake St River Forest IL 5 (Chicago) 03/27/2018 ZLHS21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0321 Hazardous Areas - Enclosure Standard
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0355 Portable Fire Extinguishers Standard
K0915 Essential Electrical Systems ? Type 1 and Type 2 Standard
14C0001024 Edwardsville Ambulatory Surg Ctr, Llc 12 Ginger Creek Professional Pkwy Glen Carbon IL 5 (Chicago) 09/17/2024 640AE-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0080 QUALITY ASSESSMENT AND PERFORMANCE Condition
Q0100 ENVIRONMENT Condition
Q0240 INFECTION CONTROL Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0036 EP Training and Testing Standard
E0039 EP Testing Requirements Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0104 SAFETY FROM FIRE Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0244 INFECTION CONTROL PROGRAM - QAPI Standard
Q0245 INFECTION CONTROL PROGRAM Standard
14C0001024 Edwardsville Ambulatory Surg Ctr, Llc 12 Ginger Creek Professional Pkwy Glen Carbon IL 5 (Chicago) 09/17/2024 640AE-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0902 Gas and Vacuum Piped Systems - Other Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
14C0001024 Edwardsville Ambulatory Surg Ctr, Llc 12 Ginger Creek Professional Pkwy Glen Carbon IL 5 (Chicago) 09/16/2020 WP2O11 Focused Infection Control, Other-Fed, 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
14C0001024 Edwardsville Ambulatory Surg Ctr, Llc 12 Ginger Creek Professional Pkwy Glen Carbon IL 5 (Chicago) 09/16/2020 WP2O21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0222 Egress Doors Standard
K0292 Means of Egress Standard
K0341 Fire Alarm System - Installation Standard
14C0001025 Southwestern Medical Center Llc 7456 S State Road Bedford Park IL 5 (Chicago) 12/29/2022 5E9DF-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
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0221 NOTICE OF RIGHTS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard