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
▼ 05C0001460 Gold Med Surgery Center, Inc 16311 Ventura Blvd, Suite 1010 Encino CA 9 (San Francisco) 04/05/2018 V87Z21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0009 Local, State, Tribal Collaboration Process Standard
E0034 Information on Occupancy/Needs Standard
E0036 EP Training and Testing Standard
K0291 Emergency Lighting Standard
K0351 Sprinkler System - Installation Standard
▼ 05C0001460 Gold Med Surgery Center, Inc 16311 Ventura Blvd, Suite 1010 Encino CA 9 (San Francisco) 03/22/2018 V87Z11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0060 SURGICAL SERVICES Condition
Q0080 QUALITY ASSESSMENT AND PERFORMANCE Condition
Q0120 MEDICAL STAFF Condition
Q0140 NURSING SERVICES Condition
Q0160 MEDICAL RECORDS Condition
Q0180 PHARMACEUTICAL SERVICES Condition
Q0240 INFECTION CONTROL Condition
Q0260 PATIENT ADMISSION, ASSESSMENT AND DISCHARGE Condition
Q0002 DEFINITIONS Standard
Q0041 CONTRACT SERVICES Standard
Q0042 HOSPITALIZATION Standard
Q0063 ADMINISTRATION OF ANESTHESIA Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0106 EMERGENCY PERSONNEL Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0122 REAPPRAISALS Standard
Q0123 OTHER PRACTITIONERS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0203 RADIOLOGIC SERVICES Standard
Q0204 RADIOLOGIC SERVICES Standard
Q0232 SAFETY Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
Q0244 INFECTION CONTROL PROGRAM - QAPI Standard
Q0261 ADMISSION ASSESSMENT Standard
Q0262 PRE-SURGICAL ASSESSMENT Standard
Q0263 ADMISSION ASSESSMENT - RECORD Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
Q0266 DISCHARGE - ORDER Standard
▼ 05C0001465 Silicon Valley Surgery Center 2605 S. Winchester Blvd Campbell CA 9 (San Francisco) 04/01/2026 1F29F1-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0234 CONFIDENTIALITY OF CLINICAL RECORDS Standard
▼ 05C0001465 Silicon Valley Surgery Center 2605 S. Winchester Blvd Campbell CA 9 (San Francisco) 09/04/2024 64197-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0342 Fire Alarm System - Initiation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0781 Portable Space Heaters Standard
▼ 05C0001465 Silicon Valley Surgery Center 2605 S. Winchester Blvd Campbell CA 9 (San Francisco) 01/21/2020 ZN0U11 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0184 VERBAL ORDERS Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
▼ 05C0001465 Silicon Valley Surgery Center 2605 S. Winchester Blvd Campbell CA 9 (San Francisco) 04/25/2019 I04B21 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
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0511 Utilities - Gas and Electric Standard
K0908 Gas and Vacuum Piped Systems ? Central Supply System Alarms 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
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 05C0001465 Silicon Valley Surgery Center 2605 S. Winchester Blvd Campbell CA 9 (San Francisco) 01/18/2019 I04B11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0062 ANESTHETIC - DISCHARGE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001470 Premier Surgery Center 231 West Pueblo Street Santa Barbara CA 9 (San Francisco) 02/05/2020 F8IE21 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
E0032 Primary/Alternate Means for Communication Standard
E0039 EP Testing Requirements Standard
K0291 Emergency Lighting 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
K0354 Sprinkler System - Out of Service Standard
K0919 Electrical Equipment - Other Standard
▼ 05C0001470 Premier Surgery Center 231 West Pueblo Street Santa Barbara CA 9 (San Francisco) 01/24/2020 F8IE11 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
Q0240 INFECTION CONTROL Condition
Q0041 CONTRACT SERVICES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0201 LABORATORY SERVICES Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 05C0001471 Redding Surgery Center, Llc 1238 West Street Redding CA 9 (San Francisco) 05/22/2019 4C7X11 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0101 PHYSICAL ENVIRONMENT Standard