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
▼ 05C0001066 Forest Surgery Center 2110 Forest Avenue San Jose CA 9 (San Francisco) 01/16/2020 7UDY11 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0223 NOTICE - PHYSICIAN OWNERSHIP Standard
▼ 05C0001068 North Bay Eye Associates, Asc 380 Tesconi Court Santa Rosa CA 9 (San Francisco) 11/17/2025 1D656E-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0039 EP Testing Requirements Standard
K0223 Doors with Self-Closing Devices Standard
K0341 Fire Alarm System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0711 Evacuation and Relocation Plan Standard
K0712 Fire Drills Standard
K0919 Electrical Equipment - Other Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 05C0001068 North Bay Eye Associates, Asc 380 Tesconi Court Santa Rosa CA 9 (San Francisco) 09/17/2025 1D656E-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0122 REAPPRAISALS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0263 ADMISSION ASSESSMENT - RECORD Standard
▼ 05C0001077 San Joaquin Laser & Surgery Center 1805 N California Street, Suite 101a Stockton CA 9 (San Francisco) 07/08/2019 NE1N21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0006 Plan Based on All Hazards Risk Assessment Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0030 Names and Contact Information Standard
E0039 EP Testing Requirements Standard
K0161 Building Construction Type and Height Standard
K0222 Egress Doors Standard
K0223 Doors with Self-Closing Devices Standard
K0293 Exit Signage Standard
K0321 Hazardous Areas - Enclosure Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
K0521 HVAC Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
K0926 Gas Equipment - Qualifications and Training Standard
▼ 05C0001077 San Joaquin Laser & Surgery Center 1805 N California Street, Suite 101a Stockton CA 9 (San Francisco) 05/24/2019 NE1N11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0201 LABORATORY SERVICES Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0266 DISCHARGE - ORDER Standard
▼ 05C0001080 Riverside Medical Clinic Surgery Center 7160 Brockton Avenue--1st Floor Riverside CA 9 (San Francisco) 05/22/2024 62E57-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0240 INFECTION CONTROL Condition
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0245 INFECTION CONTROL PROGRAM Standard
▼ 05C0001080 Riverside Medical Clinic Surgery Center 7160 Brockton Avenue--1st Floor Riverside CA 9 (San Francisco) 12/22/2020 J4L011 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0225 SUBMISSION AND INVESTIGATION OF GRIEVANCES Standard
▼ 05C0001085 California Eye Clinic 3747 Sunset Lane Antioch CA 9 (San Francisco) 02/14/2019 7CCS11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0180 PHARMACEUTICAL SERVICES Condition
Q0240 INFECTION CONTROL Condition
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0231 PRIVACY Standard
Q0232 SAFETY 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
▼ 05C0001087 Surgery Center Of Northern Ca 950 Butte St Redding CA 9 (San Francisco) 09/16/2025 1D5C92-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0039 EP Testing Requirements Standard
K0342 Fire Alarm System - Initiation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0355 Portable Fire Extinguishers Standard
K0712 Fire Drills Standard
K0741 Smoking Regulations Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0933 Features of Fire Protection ? Fire Loss Prevention Standard
▼ 05C0001087 Surgery Center Of Northern Ca 950 Butte St Redding CA 9 (San Francisco) 09/11/2025 1D5C92-H1 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0109 EMERGENCY EQUIPMENT Standard
Q0122 REAPPRAISALS Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard