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
▼ 05C0001874 Rancho Mirage Surgery Center 35800 Bob Hope Drive, Suite 100 Rancho Mirage CA 9 (San Francisco) 12/17/2019 DY0R11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0241 SANITARY ENVIRONMENT Standard
Q0261 PATIENT ASSESSMENT AND ADMISSION Standard
▼ 05C0001879 Scripps Clinic Ambulatory Surgery Center - Rancho Bernardo 15004 Innovation Drive San Diego CA 9 (San Francisco) 04/26/2018 28U621 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
E0036 EP Training and Testing Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 05C0001879 Scripps Clinic Ambulatory Surgery Center - Rancho Bernardo 15004 Innovation Drive San Diego CA 9 (San Francisco) 04/18/2018 28U611 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0266 DISCHARGE - ORDER Standard
▼ 05C0001880 Martin Luther King, Jr Ambulatory Surgery Center 1670 E 120th Street Los Angeles CA 9 (San Francisco) 07/09/2019 Z93W21 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
K0353 Sprinkler System - Maintenance and Testing Standard
K0374 Subdivision of Building Spaces ? Smoke Barrier Doors Standard
K0711 Evacuation and Relocation Plan Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0923 Electrical Equipment ? Ground-Fault Circuit-Interrupter Protection Standard
K0933 Features of Fire Protection ? Fire Loss Prevention Standard
▼ 05C0001880 Martin Luther King, Jr Ambulatory Surgery Center 1670 E 120th Street Los Angeles CA 9 (San Francisco) 06/11/2019 Z93W11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0081 PROGRAM SCOPE; PROGRAM ACTIVITIES Standard
Q0084 GOVERNING BODY RESPONSIBILITIES Standard
Q0109 EMERGENCY EQUIPMENT Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0244 INFECTION CONTROL PROGRAM - QAPI Standard
▼ 05C0001883 Orangewood Surgical Center Llc 2143 Orangewood Avenue Orange CA 9 (San Francisco) 02/14/2025 655E3-H1 Complaint
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
▼ 05C0001888 Sutter Valley Medical Foundation 8011 Don Avenue Stockton CA 9 (San Francisco) 04/14/2025 65BFA-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
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
K0904 Gas and Vacuum Piped Systems ? Warning Systems Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
K0919 Electrical Equipment - Other Standard
▼ 05C0001888 Sutter Valley Medical Foundation 8011 Don Avenue Stockton CA 9 (San Francisco) 04/10/2025 65BFA-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
▼ 05C0001894 Broadway Surgical Institute, Inc 1451 South Broadway Street Santa Monica CA 9 (San Francisco) 04/11/2018 1T5V21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0331 Interior Wall and Ceiling Finish Standard
K0751 Draperies, Curtains, and Loosely Hanging Fabrics Standard
K0929 Gas Equipment ? Precautions for Handling Oxygen Standard
▼ 05C0001894 Broadway Surgical Institute, Inc 1451 South Broadway Street Santa Monica CA 9 (San Francisco) 03/29/2018 1T5V11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0101 PHYSICIAL ENVIRONMENT Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0222 NOTICE OF RIGHTS - POSTING Standard
Q0241 SANITARY ENVIRONMENT Standard