S&C QCOR ASC 2567s
d QCOR: Quality, Certification and Oversight Reports. S&C QCOR  
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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
▼ 05C0001370 Peninsula Endoscopy Center, Llc 1720 El Camino Real, Suite 100 Burlingame CA 9 (San Francisco) 08/11/2025 1D2BCA-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
K0161 Building Construction Type and Height Standard
K0712 Fire Drills Standard
▼ 05C0001370 Peninsula Endoscopy Center, Llc 1720 El Camino Real, Suite 100 Burlingame CA 9 (San Francisco) 08/07/2025 1D2BCA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0162 FORM AND CONTENT OF RECORD Standard
Q0184 VERBAL ORDERS Standard
▼ 05C0001373 China Lake Surgery Center, Llc 1111 North China Lake Blvd, No 2a Ridgecrest CA 9 (San Francisco) 11/27/2018 YXOZ21 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
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
E0036 EP Training and Testing Standard
K0223 Doors with Self-Closing Devices Standard
K0321 Hazardous Areas - Enclosure Standard
K0521 HVAC Standard
K0912 Electrical Systems - Receptacles Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 05C0001373 China Lake Surgery Center, Llc 1111 North China Lake Blvd, No 2a Ridgecrest CA 9 (San Francisco) 09/19/2018 YXOZ11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0244 INFECTION CONTROL PROGRAM - QAPI Standard
Q0245 INFECTION CONTROL PROGRAM Standard
▼ 05C0001375 Wika Endoscopy Center 18056 Wika Rd, Suite D Apple Valley CA 9 (San Francisco) 08/21/2019 3K9L21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0022 Policies/Procedures for Sheltering in Place Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0033 Methods for Sharing Information Standard
E0039 EP Testing Requirements Standard
K0291 Emergency Lighting Standard
K0341 Fire Alarm System - Installation Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 05C0001375 Wika Endoscopy Center 18056 Wika Rd, Suite D Apple Valley CA 9 (San Francisco) 06/26/2019 3K9L11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001384 Mill Creek Ambulatory Surgery Center 2822 Wes Main Street Visalia CA 9 (San Francisco) 10/17/2018 F43B21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0223 Doors with Self-Closing Devices Standard
K0323 Anesthetizing Locations Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0712 Fire Drills Standard
▼ 05C0001384 Mill Creek Ambulatory Surgery Center 2822 Wes Main Street Visalia CA 9 (San Francisco) 08/08/2018 F43B11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0120 MEDICAL STAFF Condition
Q0240 INFECTION CONTROL Condition
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001386 San Mateo Surgery Center 66 Bovet Road Suite 101 San Mateo CA 9 (San Francisco) 05/30/2018 1PMF21 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
E0013 Development of EP Policies and Procedures Standard
E0029 Development of Communication Plan Standard
K0161 Building Construction Type and Height Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0355 Portable Fire Extinguishers Standard
K0521 HVAC Standard
K0712 Fire Drills Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 05C0001386 San Mateo Surgery Center 66 Bovet Road Suite 101 San Mateo CA 9 (San Francisco) 04/13/2018 1PMF11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0080 QUALITY ASSESSMENT AND PERFORMANCE Condition
Q0100 ENVIRONMENT Condition
Q0140 NURSING SERVICES Condition
Q0200 LABORATORY AND RADIOLOGIC SERVICES Condition
Q0240 INFECTION CONTROL Condition
Q0260 PATIENT ADMISSION, ASSESSMENT AND DISCHARGE Condition
Q0041 CONTRACT SERVICES Standard
Q0042 HOSPITALIZATION Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0105 EMERGENCY EQUIPMENT Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0122 REAPPRAISALS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0201 LABORATORY SERVICES Standard
Q0203 RADIOLOGIC SERVICES Standard
Q0204 RADIOLOGIC SERVICES Standard
Q0223 NOTICE - PHYSICIAN OWNERSHIP Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 ADMISSION ASSESSMENT Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard