S&C QCOR ASC 2567s
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ASCs 2567s
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Time Interval

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Provider Characteristics

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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
▼ 05C0001661 Pacific Heights Surgery Center Of San Francisco, Lp 3000 California Street San Francisco CA 9 (San Francisco) 05/15/2019 Q4FB21 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
K0300 Protection - Other Standard
K0341 Fire Alarm System - Installation Standard
K0355 Portable Fire Extinguishers Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 05C0001661 Pacific Heights Surgery Center Of San Francisco, Lp 3000 California Street San Francisco CA 9 (San Francisco) 02/22/2019 Q4FB11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0080 QUALITY ASSESSMENT AND PERFORMANCE Condition
Q0100 ENVIRONMENT Condition
Q0120 MEDICAL STAFF Condition
Q0240 INFECTION CONTROL Condition
Q0041 CONTRACT SERVICES Standard
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0102 SEPARATION Standard
Q0122 REAPPRAISALS Standard
Q0123 OTHER PRACTITIONERS Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0201 LABORATORY SERVICES Standard
Q0203 RADIOLOGIC SERVICES Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
Q0266 DISCHARGE - ORDER Standard
▼ 05C0001662 Templeton Endoscopy Center 1320 Las Tablas Ste A Templeton CA 9 (San Francisco) 09/06/2019 00V521 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0039 EP Testing Requirements Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
▼ 05C0001662 Templeton Endoscopy Center 1320 Las Tablas Ste A Templeton CA 9 (San Francisco) 08/22/2019 00V511 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0240 INFECTION CONTROL Condition
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001663 Skyway Surgery Center, Llc 121 Raley Blvd Chico CA 9 (San Francisco) 07/21/2025 6628A-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0521 HVAC Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 05C0001663 Skyway Surgery Center, Llc 121 Raley Blvd Chico CA 9 (San Francisco) 05/23/2025 6628A-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0203 RADIOLOGIC SERVICES Standard
Q0221 NOTICE OF RIGHTS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 05C0001665 Bay Area Endoscopy Center, Llc 20998 Redwood Road Castro Valley CA 9 (San Francisco) 02/07/2018 YBHN21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard
K0511 Utilities - Gas and Electric Standard
▼ 05C0001667 San Francisco Surgery Center, Lp 450 Sutter Street, Suite 500 San Francisco CA 9 (San Francisco) 07/15/2019 JTRR21 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
E0006 Plan Based on All Hazards Risk Assessment Standard
E0007 EP Program Patient Population Standard
E0018 Procedures for Tracking of Staff and Patients Standard
E0020 Policies for Evac. and Primary/Alt. Comm. Standard
E0022 Policies/Procedures for Sheltering in Place Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0030 Names and Contact Information Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
K0223 Doors with Self-Closing Devices Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0355 Portable Fire Extinguishers Standard
K0372 Subdivision of Building Spaces ? Smoke Barrier Construction Standard
K0511 Utilities - Gas and Electric Standard
K0712 Fire Drills Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 05C0001667 San Francisco Surgery Center, Lp 450 Sutter Street, Suite 500 San Francisco CA 9 (San Francisco) 05/16/2019 JTRR11 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
Q0100 ENVIRONMENT Condition
Q0120 MEDICAL STAFF Condition
Q0140 NURSING SERVICES Condition
Q0180 PHARMACEUTICAL SERVICES Condition
Q0240 INFECTION CONTROL Condition
Q0260 PATIENT ADMISSION, ASSESSMENT AND DISCHARGE Condition
Q0002 DEFINITIONS Standard
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0101 PHYSICAL ENVIRONMENT 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
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
▼ 05C0001668 Pacific Surgery Center Of Ventura 3805 Telegraph Rd Ventura CA 9 (San Francisco) 04/03/2025 64FA4-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0323 Anesthetizing Locations Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0521 HVAC Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard