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
▼ 05C0001778 Brentwood Surgery Center 2400 Balfour Road, Third Floor, Suite 320 Brentwood CA 9 (San Francisco) 05/16/2018 LU0S21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0355 Portable Fire Extinguishers Standard
K0781 Portable Space Heaters Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
▼ 05C0001778 Brentwood Surgery Center 2400 Balfour Road, Third Floor, Suite 320 Brentwood CA 9 (San Francisco) 03/06/2018 LU0S11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 05C0001779 Otay Lakes Surgery Center, Llc 955 Lane Avenue, Suite 100 Chula Vista CA 9 (San Francisco) 05/01/2019 4M8W21 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
E0033 Methods for Sharing Information Standard
E0037 EP Training Program Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0912 Electrical Systems - Receptacles Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 05C0001779 Otay Lakes Surgery Center, Llc 955 Lane Avenue, Suite 100 Chula Vista CA 9 (San Francisco) 02/13/2019 4M8W11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0141 ORGANIZATION AND STAFFING Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 05C0001780 Sylvan Surgery Center, Inc 2336 Sylvan Avenue Modesto CA 9 (San Francisco) 06/26/2019 8WSC21 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
E0032 Primary/Alternate Means for Communication Standard
E0033 Methods for Sharing Information Standard
K0161 Building Construction Type and Height Standard
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0355 Portable Fire Extinguishers Standard
K0914 Electrical Systems - 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
▼ 05C0001780 Sylvan Surgery Center, Inc 2336 Sylvan Avenue Modesto CA 9 (San Francisco) 05/29/2019 8WSC11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0100 ENVIRONMENT Condition
Q0140 NURSING SERVICES Condition
Q0180 PHARMACEUTICAL SERVICES Condition
Q0240 INFECTION CONTROL Condition
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0221 NOTICE OF RIGHTS Standard
Q0223 NOTICE - PHYSICIAN OWNERSHIP Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard
▼ 05C0001784 Golden Gate Endoscopy Center, Llc 3370 Geary Boulevard, First Floor San Francisco CA 9 (San Francisco) 06/30/2025 667B7-L1 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
K0341 Fire Alarm System - Installation Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0711 Evacuation and Relocation Plan Standard
K0919 Electrical Equipment - Other Standard
▼ 05C0001784 Golden Gate Endoscopy Center, Llc 3370 Geary Boulevard, First Floor San Francisco CA 9 (San Francisco) 06/26/2025 667B7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0240 INFECTION CONTROL Condition
E0039 EP Testing Requirements Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 05C0001796 Surgery Center Of The Pacific 2121 Wilshire Boulevard, Suite #201 Santa Monica CA 9 (San Francisco) 12/26/2019 KSNJ21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0100 General Requirements - Other Standard
▼ 05C0001796 Surgery Center Of The Pacific 2121 Wilshire Boulevard, Suite #201 Santa Monica CA 9 (San Francisco) 12/12/2019 KSNJ11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0041 CONTRACT SERVICES Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0063 ADMINISTRATION OF ANESTHESIA Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0222 NOTICE OF RIGHTS - POSTING Standard
Q0224 ADVANCED DIRECTIVES Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
Q0265 DISCHARGE - SUPPLIES AND INFORMATION Standard
Q0266 DISCHARGE - ORDER Standard
Q0267 DISCHARGE WITH RESPONSIBLE ADULT Standard