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
▼ 05C0001721 Spanish Hills Surgery Center Llc 4542 Las Posas Road, Suite C Camarillo CA 9 (San Francisco) 09/04/2019 FKM721 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0023 Policies/Procedures for Medical Documentation Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
K0161 Building Construction Type and Height Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0919 Electrical Equipment - Other Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
▼ 05C0001721 Spanish Hills Surgery Center Llc 4542 Las Posas Road, Suite C Camarillo CA 9 (San Francisco) 08/08/2019 FKM711 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0002 DEFINITIONS Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0203 RADIOLOGIC SERVICES Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001722 Garden Grove Surgical Center 12894 Harbor Blvd Garden Grove CA 9 (San Francisco) 04/29/2019 QXUH11 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0225 SUBMISSION AND INVESTIGATION OF GRIEVANCES Standard
▼ 05C0001722 Garden Grove Surgical Center 12894 Harbor Blvd Garden Grove CA 9 (San Francisco) 04/25/2018 7NQF21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0036 EP Training and Testing Standard
K0293 Exit Signage Standard
K0321 Hazardous Areas - Enclosure Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0741 Smoking Regulations Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 05C0001722 Garden Grove Surgical Center 12894 Harbor Blvd Garden Grove CA 9 (San Francisco) 03/16/2018 7NQF11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0105 EMERGENCY EQUIPMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 ADMISSION ASSESSMENT Standard
▼ 05C0001724 Chevy Chase Ambulatory Center 801 South Chevy Chase Drive, #106 Glendale CA 9 (San Francisco) 03/13/2018 LK0V21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0020 Policies for Evac. and Primary/Alt. Comm. Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0034 Information on Occupancy/Needs Standard
K0331 Interior Wall and Ceiling Finish Standard
K0712 Fire Drills Standard
K0929 Gas Equipment ? Precautions for Handling Oxygen Standard
▼ 05C0001724 Chevy Chase Ambulatory Center 801 South Chevy Chase Drive, #106 Glendale CA 9 (San Francisco) 02/23/2018 LK0V11 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
Q0100 ENVIRONMENT Condition
Q0240 INFECTION CONTROL Condition
Q0041 CONTRACT SERVICES Standard
Q0082 PROGRAM DATA; PROGRAM ACTIVITIES Standard
Q0083 PERFORMANCE IMPROVEMENT PROJECTS Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0262 PRE-SURGICAL ASSESSMENT Standard
▼ 05C0001726 Interventional Pain Center Of Merced 1390 East Yosemite Avenue, Suite C Merced CA 9 (San Francisco) 07/30/2019 H08E21 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
E0018 Procedures for Tracking of Staff and Patients Standard
E0022 Policies/Procedures for Sheltering in Place Standard
E0023 Policies/Procedures for Medical Documentation Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
E0030 Names and Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
E0034 Information on Occupancy/Needs Standard
E0039 EP Testing Requirements Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 05C0001726 Interventional Pain Center Of Merced 1390 East Yosemite Avenue, Suite C Merced CA 9 (San Francisco) 07/10/2019 H08E11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0240 INFECTION CONTROL Condition
Q0002 DEFINITIONS Standard
Q0201 LABORATORY SERVICES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0243 INFECTION CONTROL PROGRAM - DIRECTION Standard
▼ 05C0001727 San Gabriel Ambulatory Surgery Center 207 South Santa Anita Avenue, Suite G San Gabriel CA 9 (San Francisco) 10/31/2019 EXQ111 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0241 SANITARY ENVIRONMENT Standard