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
▼ 55C0001041 M/S Surgery Center 3510 Martin Luther King Blvd Lynwood CA 9 (San Francisco) 03/15/2018 983S11 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0240 INFECTION CONTROL Condition
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
▼ 55C0001044 Lakewood Eye Physicians And Surgeons 3300 East South St Long Beach CA 9 (San Francisco) 01/24/2019 ARBT21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0346 Fire Alarm System - Out of Service Standard
▼ 55C0001044 Lakewood Eye Physicians And Surgeons 3300 East South St Long Beach CA 9 (San Francisco) 01/02/2019 ARBT11 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
Q0240 INFECTION CONTROL Condition
Q0063 ADMINISTRATION OF ANESTHESIA Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0245 INFECTION CONTROL PROGRAM Standard
Q0266 DISCHARGE - ORDER Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard
▼ 55C0001053 Fremont Ambulatory Surgery Center, Lp 39350 Civic Center Drive, Suite 100 Fremont CA 9 (San Francisco) 01/18/2018 UM6811 Complaint, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0042 HOSPITALIZATION Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 55C0001055 San Fernando Valley Surgery Center, Lp 11550 Indian Hills Rd, Suite 160 Mission Hills CA 9 (San Francisco) 08/09/2021 XZ5011 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0225 SUBMISSION AND INVESTIGATION OF GRIEVANCES Standard
▼ 55C0001059 Fort Sutter Surgery Center, A Ca Limited Partnership 2801 K Street, Suite 525 Sacramento CA 9 (San Francisco) 05/12/2026 22FDDC-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0211 Means of Egress - General Standard
K0223 Doors with Self-Closing Devices Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0355 Portable Fire Extinguishers Standard
K0521 HVAC Standard
K0711 Evacuation and Relocation Plan Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 55C0001059 Fort Sutter Surgery Center, A Ca Limited Partnership 2801 K Street, Suite 525 Sacramento CA 9 (San Francisco) 05/07/2026 22FDDC-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0060 SURGICAL SERVICES Condition
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 55C0001059 Fort Sutter Surgery Center, A Ca Limited Partnership 2801 K Street, Suite 525 Sacramento CA 9 (San Francisco) 04/10/2019 NROJ21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0037 EP Training Program Standard
K0343 Fire Alarm System - Notification 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
K0355 Portable Fire Extinguishers Standard
K0521 HVAC Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 55C0001059 Fort Sutter Surgery Center, A Ca Limited Partnership 2801 K Street, Suite 525 Sacramento CA 9 (San Francisco) 02/01/2019 NROJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 55C0001061 Pacific Eye Institute 555 N 13th Avenue Upland CA 9 (San Francisco) 07/28/2025 669F3-L1 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
E0039 EP Testing Requirements Standard
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0355 Portable Fire Extinguishers Standard
K0521 HVAC Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0926 Gas Equipment - Qualifications and Training Standard