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
▼ 24C0001025 High Pointe Surgery Center 8650 Hudson Blvd, Suite 235 Lake Elmo MN 5 (Chicago) 04/30/2024 62621-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0311 Vertical Openings - Enclosure Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0521 HVAC Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 24C0001026 Lakewalk Surgery Center Inc 1420 London Road, Suite 100 Duluth MN 5 (Chicago) 06/10/2020 UI5W11 Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 24C0001029 South Central Surgical Center, Llc 717 South State Street, Suite 1000 Fairmont MN 5 (Chicago) 05/02/2019 ESBK11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
E0004 Develop EP Plan, Review and Update Annually Standard
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0122 REAPPRAISALS Standard
Q0123 OTHER PRACTITIONERS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0220 NOTICE - POSTING Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0266 DISCHARGE - ORDER Standard
▼ 24C0001029 South Central Surgical Center, Llc 717 South State Street, Suite 1000 Fairmont MN 5 (Chicago) 04/30/2019 ESBK21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0901 Fundamentals - Building System Categories Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0916 Essential Electrical Systems ? Alarm Annunciator Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
K0926 Gas Equipment - Qualifications and Training Standard
▼ 24C0001032 Mccannel Eye Surgery 3124 West 70th Street Edina MN 5 (Chicago) 02/07/2020 DEUL11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0224 ADVANCED DIRECTIVES Standard
Q0245 INFECTION CONTROL PROGRAM Standard
▼ 24C0001037 Mngi Endoscopy Asc, Inc 15700 37th Avenue North Suite 300 Plymouth MN 5 (Chicago) 06/12/2019 U5PO11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
E0018 Procedures for Tracking of Staff and Patients Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0037 EP Training Program Standard
Q0101 PHYSICAL ENVIRONMENT Standard
▼ 24C0001039 St. Cloud Center For Ophthalmic Surgery 2055 15th Street North, Suite B St Cloud MN 5 (Chicago) 08/14/2019 P83511 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0229 EXERCISE OF RIGHTS - INFORMED CONSENT Standard
▼ 24C0001040 Rayus Twin Cities Asc 5775 Wayzata Blvd, Suite 190 Saint Louis Park MN 5 (Chicago) 01/23/2020 2O3U11 Recertification
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
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 24C0001040 Rayus Twin Cities Asc 5775 Wayzata Blvd, Suite 190 Saint Louis Park MN 5 (Chicago) 01/22/2020 2O3U21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0321 Hazardous Areas - Enclosure Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0521 HVAC Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0915 Essential Electrical Systems ? Type 1 and Type 2 Standard
▼ 24C0001042 Southwest Surgical Center, Llc 8100 West 78th Street, Suite 220 Edina MN 5 (Chicago) 05/22/2024 62BE7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard