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
▼ 05C0001428 4th Street Laser And Surgery Center 1720 4th Street Santa Rosa CA 9 (San Francisco) 02/05/2020 7NHI21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0037 EP Training Program Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0521 HVAC Standard
K0712 Fire Drills Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0926 Gas Equipment - Qualifications and Training Standard
▼ 05C0001428 4th Street Laser And Surgery Center 1720 4th Street Santa Rosa CA 9 (San Francisco) 01/08/2020 7NHI11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0232 SAFETY Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001429 Paincare Surgicenter 15701 Rockfield Blvd Irvine CA 9 (San Francisco) 06/20/2018 86RL21 Recertification, Sample Validation
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
E0036 EP Training and Testing Standard
K0331 Interior Wall and Ceiling Finish Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0355 Portable Fire Extinguishers Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
▼ 05C0001429 Paincare Surgicenter 15701 Rockfield Blvd Irvine CA 9 (San Francisco) 05/31/2018 86RL11 Recertification, Sample Validation
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
Q0240 INFECTION CONTROL Condition
Q0002 DEFINITIONS Standard
Q0041 CONTRACT SERVICES Standard
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0203 RADIOLOGIC SERVICES Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0234 CONFIDENTIALITY OF CLINICAL RECORDS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0245 INFECTION CONTROL PROGRAM Standard
Q0261 ADMISSION ASSESSMENT Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard
▼ 05C0001436 Pacific Surgical Institute Of Pain Management 3703 Camino Del Rio South, Ste 101 San Diego CA 9 (San Francisco) 03/21/2018 X8JB21 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
K0311 Vertical Openings - Enclosure Standard
K0712 Fire Drills Standard
K0741 Smoking Regulations Standard
▼ 05C0001436 Pacific Surgical Institute Of Pain Management 3703 Camino Del Rio South, Ste 101 San Diego CA 9 (San Francisco) 02/21/2018 X8JB11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0181 ADMINISTRATION OF DRUGS Standard
▼ 05C0001438 Marin Endoscopy Center, Llc 1100 South Eliseo Drive, Suite 3 Greenbrae CA 9 (San Francisco) 10/30/2018 ZUE721 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0029 Development of Communication Plan Standard
K0321 Hazardous Areas - Enclosure Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0371 Subdivision of Building Spaces ? Smoke Compartments Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 05C0001445 Orthopedic Surgery Center Of Orange County, Llc 22 Corporate Plaza, Suite 150 Newport Beach CA 9 (San Francisco) 03/21/2019 7S5321 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0026 Roles Under a Waiver Declared by Secretary Standard
E0032 Primary/Alternate Means for Communication Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 05C0001445 Orthopedic Surgery Center Of Orange County, Llc 22 Corporate Plaza, Suite 150 Newport Beach CA 9 (San Francisco) 02/06/2019 7S5311 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0122 REAPPRAISALS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 05C0001447 Coast Surgery Center Lp 3445 Pacific Coast Highway, Suite 110 Torrance CA 9 (San Francisco) 10/30/2019 O5D011 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0203 RADIOLOGIC SERVICES Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0229 EXERCISE OF RIGHTS - INFORMED CONSENT Standard
Q0231 PRIVACY Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard