| CMS Certification Number |
Facility Name |
Address |
City |
State |
CMS Region |
Date of CMS Survey |
Survey Event ID |
Survey Type |
Statement of Deficiencies Report |
|
▼
23C0001129
|
Mps Asc Ventures Inkster, Llc |
29110 Inkster Rd, Suite 100 |
Southfield |
MI |
5 (Chicago) |
09/04/2025 |
1D5645-L1 |
Recertification |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| E0000 |
Initial Comments - Not a Deficiency Citation |
Memo |
|
| K0000 |
INITIAL COMMENTS |
Memo |
|
| K0346 |
Fire Alarm System - Out of Service |
Standard |
|
| K0712 |
Fire Drills |
Standard |
|
| K0918 |
Essential Electrical Systems ? Generator or Alternate Source |
Standard |
|
|
|
▼
23C0001129
|
Mps Asc Ventures Inkster, Llc |
29110 Inkster Rd, Suite 100 |
Southfield |
MI |
5 (Chicago) |
02/24/2021 |
GH6O11 |
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 |
|
| Q0062 |
ANESTHETIC - DISCHARGE |
Standard |
|
|
|
▼
23C0001134
|
Mt. Pleasant Surgery Center, Llc |
4851 East Pickard Street |
Mount Pleasant |
MI |
5 (Chicago) |
02/05/2020 |
ZX4611 |
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 |
|
| Q0101 |
PHYSICAL ENVIRONMENT |
Standard |
|
| Q0104 |
SAFETY FROM FIRE |
Standard |
|
|
|
▼
23C0001134
|
Mt. Pleasant Surgery Center, Llc |
4851 East Pickard Street |
Mount Pleasant |
MI |
5 (Chicago) |
02/05/2020 |
ZX4621 |
Recertification, Sample Validation |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| K0000 |
INITIAL COMMENTS |
Memo |
|
| K0131 |
Multiple Occupancies |
Standard |
|
| K0918 |
Essential Electrical Systems ? Generator or Alternate Source |
Standard |
|
|
|
▼
23C0001135
|
Rochester Endoscopy And Surgery Center, Llc |
1349 S Rochester Rd, Suite 150 |
Rochester Hills |
MI |
5 (Chicago) |
07/07/2021 |
9DH511 |
Recertification |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| Q0000 |
Initial Comments - Not a Deficiency Citation |
Memo |
|
| Q0160 |
MEDICAL RECORDS |
Condition |
|
| Q0104 |
SAFETY FROM FIRE |
Standard |
|
| Q0161 |
ORGANIZATION |
Standard |
|
| Q0241 |
SANITARY ENVIRONMENT |
Standard |
|
|
|
▼
23C0001135
|
Rochester Endoscopy And Surgery Center, Llc |
1349 S Rochester Rd, Suite 150 |
Rochester Hills |
MI |
5 (Chicago) |
07/07/2021 |
9DH521 |
Recertification |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| E0000 |
Initial Comments - Not a Deficiency Citation |
Memo |
|
| K0000 |
INITIAL COMMENTS |
Memo |
|
| K0223 |
Doors with Self-Closing Devices |
Standard |
|
| K0232 |
Aisle, Corridor, or Ramp Width |
Standard |
|
| K0919 |
Electrical Equipment - Other |
Standard |
|
|
|
▼
23C0001137
|
Grand Rapids Surgical Suites, Pllc |
2505 East Paris Ave Se, Suite 105 |
Grand Rapids |
MI |
5 (Chicago) |
05/21/2026 |
23265E-H1 |
Complaint, Recertification |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| Q0000 |
Initial Comments - Not a Deficiency Citation |
Memo |
|
| Q0040 |
GOVERNING BODY AND MANAGEMENT |
Condition |
|
| Q0080 |
QUALITY ASSESSMENT AND PERFORMANCE |
Condition |
|
| Q0100 |
ENVIRONMENT |
Condition |
|
| Q0219 |
PATIENT RIGHTS |
Condition |
|
| Q0081 |
PROGRAM SCOPE; PROGRAM ACTIVITIES |
Standard |
|
| Q0082 |
PROGRAM DATA; PROGRAM ACTIVITIES |
Standard |
|
| Q0101 |
PHYSICAL ENVIRONMENT |
Standard |
|
| Q0104 |
SAFETY FROM FIRE |
Standard |
|
| Q0162 |
FORM AND CONTENT OF RECORD |
Standard |
|
| Q0232 |
SAFETY |
Standard |
|
|
|
▼
23C0001137
|
Grand Rapids Surgical Suites, Pllc |
2505 East Paris Ave Se, Suite 105 |
Grand Rapids |
MI |
5 (Chicago) |
05/20/2026 |
23265E-L1 |
Recertification |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| E0000 |
Initial Comments - Not a Deficiency Citation |
Memo |
|
| K0000 |
INITIAL COMMENTS |
Memo |
|
| E0004 |
Develop EP Plan, Review and Update Annually |
Standard |
|
| E0039 |
EP Testing Requirements |
Standard |
|
| K0321 |
Hazardous Areas - Enclosure |
Standard |
|
| K0345 |
Fire Alarm System - Testing and Maintenance |
Standard |
|
| K0353 |
Sprinkler System - Maintenance and Testing |
Standard |
|
| K0711 |
Evacuation and Relocation Plan |
Standard |
|
| K0908 |
Gas and Vacuum Piped Systems ? Central Supply System Alarms |
Standard |
|
| K0916 |
Essential Electrical Systems ? Alarm Annunciator |
Standard |
|
| K0918 |
Essential Electrical Systems ? Generator or Alternate Source |
Standard |
|
|
|
▼
23C0001137
|
Grand Rapids Surgical Suites, Pllc |
2505 East Paris Ave Se, Suite 105 |
Grand Rapids |
MI |
5 (Chicago) |
01/20/2022 |
GQUS11 |
Focused Infection Control, Other-Fed, Recertification |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| Q0000 |
Initial Comments - Not a Deficiency Citation |
Memo |
|
| Q0080 |
QUALITY ASSESSMENT AND PERFORMANCE |
Condition |
|
| Q0219 |
PATIENT RIGHTS |
Condition |
|
| Q0240 |
INFECTION CONTROL |
Condition |
|
| Q0104 |
SAFETY FROM FIRE |
Standard |
|
| Q0225 |
SUBMISSION AND INVESTIGATION OF GRIEVANCES |
Standard |
|
| Q0242 |
INFECTION CONTROL PROGRAM |
Standard |
|
| Q0243 |
INFECTION CONTROL PROGRAM - DIRECTION |
Standard |
|
| Q0244 |
INFECTION CONTROL PROGRAM - QAPI |
Standard |
|
|
|
▼
23C0001137
|
Grand Rapids Surgical Suites, Pllc |
2505 East Paris Ave Se, Suite 105 |
Grand Rapids |
MI |
5 (Chicago) |
01/20/2022 |
GQUS21 |
Recertification |
|
| Deficiency Tag |
Deficiency Description |
Tag Type |
|
| E0000 |
Initial Comments - Not a Deficiency Citation |
Memo |
|
| K0000 |
INITIAL COMMENTS |
Memo |
|
| E0039 |
EP Testing Requirements |
Standard |
|
| K0131 |
Multiple Occupancies |
Standard |
|
| K0712 |
Fire Drills |
Standard |
|
| K0918 |
Essential Electrical Systems ? Generator or Alternate Source |
Standard |
|
| K0926 |
Gas Equipment - Qualifications and Training |
Standard |
|
|