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
▼ 05C0001472 Mount Sinai Surgery Center 18425 Burbank Blvd Suite 105 Tarzana CA 9 (San Francisco) 01/31/2019 GC5Z21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0712 Fire Drills Standard
▼ 05C0001472 Mount Sinai Surgery Center 18425 Burbank Blvd Suite 105 Tarzana CA 9 (San Francisco) 01/22/2019 GC5Z11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0140 NURSING SERVICES Condition
Q0240 INFECTION CONTROL Condition
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 05C0001473 Sierra Ambulatory Surgery Center 2828 West Main Street Visalia CA 9 (San Francisco) 09/24/2019 IHT521 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0039 EP Testing Requirements Standard
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0346 Fire Alarm System - Out of Service Standard
K0712 Fire Drills Standard
K0741 Smoking Regulations Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0919 Electrical Equipment - Other Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 05C0001473 Sierra Ambulatory Surgery Center 2828 West Main Street Visalia CA 9 (San Francisco) 09/04/2019 IHT511 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0109 EMERGENCY EQUIPMENT Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001475 Newport Coast Surgery Center, Lp 1441 Avocado Avenue, Suite 103 Newport Beach CA 9 (San Francisco) 03/21/2019 2FE221 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
K0222 Egress Doors Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0521 HVAC Standard
K0907 Gas and Vacuum Piped Systems ? Central Supply System Location Standard
▼ 05C0001475 Newport Coast Surgery Center, Lp 1441 Avocado Avenue, Suite 103 Newport Beach CA 9 (San Francisco) 02/26/2019 2FE211 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0109 EMERGENCY EQUIPMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0229 EXERCISE OF RIGHTS - INFORMED CONSENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
▼ 05C0001476 Advanced Pain Management 39-700 Bob Hope Drive Suite 204 Rancho Mirage CA 9 (San Francisco) 02/14/2018 3VNB21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0353 Sprinkler System - Maintenance and Testing Standard
▼ 05C0001477 Sherman Oaks Surgery Center 5170 Sepulveda Blvd, Suite 140 Sherman Oaks CA 9 (San Francisco) 05/06/2019 P81Q21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0100 General Requirements - Other Standard
K0712 Fire Drills Standard
▼ 05C0001477 Sherman Oaks Surgery Center 5170 Sepulveda Blvd, Suite 140 Sherman Oaks CA 9 (San Francisco) 03/13/2019 P81Q11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0240 INFECTION CONTROL Condition
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0203 RADIOLOGIC SERVICES Standard
Q0204 RADIOLOGIC SERVICES Standard
Q0223 NOTICE - PHYSICIAN OWNERSHIP Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0229 EXERCISE OF RIGHTS - INFORMED CONSENT Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0245 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0266 DISCHARGE - ORDER Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard
▼ 05C0001478 Empire Surgery Center 4101 Empire Drive, Suite 130 Bakersfield CA 9 (San Francisco) 06/16/2025 66515-L1 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
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0032 Primary/Alternate Means for Communication Standard
E0039 EP Testing Requirements Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0711 Evacuation and Relocation Plan Standard
K0712 Fire Drills Standard
K0919 Electrical Equipment - Other Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard