Average — CMS composite of the measures below.
A standard survey is most likely before around September 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Immanuel's Healthcare during CMS and state inspections, most recent first.
A resident with intact cognition, a history of stroke, seizures, non-Alzheimer’s dementia, and a PASARR-positive status for intellectual disability alleged that the Administrator told him to “shut up” and mind his business during a facility event. The facility’s abuse policy required protection of residents, confidentiality of allegations, and prohibition of harassment or interference with investigations, but during a PASARR meeting the MDS nurse brought the Administrator—who was the alleged perpetrator and Abuse Coordinator—into the room after the allegation was made. The Administrator then directly confronted and argued with the resident, denied the allegation, and was reported by another staff member to have claimed the resident was fabricating the complaint in retaliation, demonstrating the facility’s failure to implement its abuse policies and procedures.
A resident with intact cognition and a PASARR-positive status for intellectual disability alleged that the Administrator and Activity Director told him to "shut up" and "mind your business" during a facility event after he complained about non-residents attending. The allegation surfaced during a PASARR meeting, where the MDS nurse brought in the Administrator—who was also the alleged perpetrator and Abuse Coordinator—to confront the resident in front of others. The Administrator denied the allegation and argued with the resident, while the Activity Director was not present. The DON later conducted the abuse investigation but did not interview the resident, did not perform a safe survey with him, and did not interview all staff present at the meeting, relying instead on statements from the Administrator, Activity Director, and MDS nurse. Despite facility policy stating all abuse allegations would be investigated, the investigation was deemed unfounded without a direct resident interview or comprehensive witness interviews, resulting in a failure to demonstrate a thorough investigation of the abuse allegation.
The facility did not maintain adequate documentation or active orders for dialysis care for three residents, including missing post-dialysis weights and communication from the dialysis center. Staff interviews revealed inconsistent processes for tracking dialysis documentation, and care plans were not fully implemented in practice. Despite residents attending their dialysis appointments, the facility's records did not reflect the required monitoring and communication.
Surveyors identified multiple deficiencies in food storage and handling, including unsealed, expired, and dented food items found in the kitchen's dry storage, refrigerator, and freezer areas. Staff interviews revealed a lack of awareness regarding these issues, despite existing policies and training on proper food storage, labeling, and the FIFO method.
A facility failed to consistently and accurately reconcile and document the administration of Lorazepam 0.5mg for a resident with dementia and on hospice care. Surveyors found discrepancies in the medication count, broken blister pack seals, and improper documentation by nursing staff. Facility policy for handling and disposing of controlled substances was not followed, leading to an inaccurate account of the medication.
A resident with multiple chronic conditions was found to have nystatin topical powder stored unsecured in her room and used during personal care, contrary to facility policy requiring all medications to be kept in locked carts and administered by nursing staff. Facility staff were unaware of the medication's presence in the room, and interviews confirmed this practice was not in line with established procedures.
A resident with a new diagnosis of bipolar disorder was not referred for a required PASRR Level II Evaluation. The initial PASRR Level I Screening did not indicate a mental illness, but after the bipolar disorder diagnosis was documented, no further PASRR Screening or Evaluation was completed as required. The MDS Coordinator confirmed the oversight and noted the absence of a facility policy on PASRR Evaluations.
A nurse failed to wear required PPE while administering medication and tube feeding to a resident on enhanced barrier precautions, despite clear signage and policy. The nurse acknowledged awareness of the precautions and the risk of infection, and the DON confirmed that staff had been trained on infection control protocols.
A resident accused an LVN of physical abuse, but the LVN failed to report the allegation to the facility's abuse coordinator or Administrator as required by Texas law. The resident, with a history of dementia and other mental health conditions, had a BIMS score indicating intact cognition. Despite the facility's policy requiring immediate reporting and investigation of abuse allegations, the incident was not documented or reported, placing residents at risk of ongoing abuse.
The facility failed to maintain an infection prevention and control program, leading to multiple instances of non-compliance with infection control protocols. Staff did not perform hand hygiene or change gloves during resident care and medication administration, and medication rooms were found in unsanitary conditions, risking contamination and infection spread.
The facility failed to maintain an effective pest control program, resulting in a significant fly infestation in two hallways. Multiple residents reported and were observed to be affected by the flies, which were seen landing on their skin, clothing, and personal items. Despite monthly pest control visits and the use of blue light traps, the problem persisted, particularly in the dining room and courtyard.
The facility failed to provide necessary grooming and personal hygiene services for two residents who were unable to perform ADLs independently. One resident had long fingernails despite family requests for trimming, and another had an unkempt beard, flaky skin, and long, dirty nails despite requesting care from the staff. Interviews revealed inconsistencies in the facility's nail care procedures.
The facility failed to ensure proper storage and handling of medications in two medication rooms, with a refrigerator found at 56 degrees Fahrenheit and inadequate lighting. Staff were unaware of the correct temperature range and the status of the medication rooms, leading to potential risks for medication integrity.
Failure to Follow Abuse Policy When Resident Reported Verbal Abuse by Administrator
Penalty
Summary
The deficiency involves the facility’s failure to implement its written abuse policy and procedure after a resident made an allegation of verbal abuse against the Administrator. The facility’s undated Abuse/Neglect policy stated that the facility would take necessary measures to protect residents from harm during and following an abuse investigation, that allegations of abuse would remain confidential, and that harassment and interfering with an investigation would result in disciplinary action. Despite this, when a resident reported during a PASARR meeting that the Administrator had told him to “shut up, mind your business and don’t say anything” during a prior fall festival, the Administrator was brought into the same meeting and directly confronted the resident about his allegation. The resident involved was an adult male with intact cognitive skills for daily decision-making, with diagnoses including stroke, seizures, and non-Alzheimer’s dementia, and a PASARR-positive status related to intellectual disability. During interview, he reported that at a fall festival he had complained that it was not fair that the festival was not just for residents, and that both the Administrator and Activity Director told him to “shut up, mind your business and don’t say anything,” though he believed the Activity Director was joking and the Administrator was serious. He did not report the allegation until his PASARR meeting, where he stated that the Administrator had spoken to him in this manner. He reported that when the Administrator came into the meeting, she denied saying this, repeatedly put her hand up to stop him from talking, argued with him about what she had said, and remained in the room until just before the other staff left. Staff interviews confirmed that the Administrator, who was also the Abuse Coordinator, was summoned into the PASARR meeting after the resident made the allegation. The MDS nurse stated she brought the Administrator into the meeting because she felt the accused had the right to face their accuser, despite acknowledging that this could cause fear of retaliation and make the resident feel unsafe reporting concerns. The ECC Service Coordinator reported that the Administrator came into the meeting, negated the resident’s claim, stated he was fabricating the allegation due to retaliation, and argued back and forth with him, without leaving the room after the allegation was made. The Administrator herself acknowledged that it was not facility policy to allow the alleged perpetrator to question the resident, and that staff were supposed to contact the DON or corporate staff if she was named as the alleged perpetrator. This sequence of events demonstrated that the facility did not follow its own abuse policy regarding protection of residents, confidentiality of allegations, and prevention of harassment or interference with the investigation process.
Failure to Thoroughly Investigate Resident’s Verbal Abuse Allegation
Penalty
Summary
The deficiency involves the facility’s failure to thoroughly investigate an allegation of verbal abuse made by Resident #1. Resident #1 was an adult male with intact cognitive skills for daily decision-making, with diagnoses including stroke, seizures, and non-Alzheimer’s dementia, and a PASARR-positive status related to intellectual disability. During a PASARR meeting on 12/02/25, he reported that during a Fall Festival on 10/15/25, the Administrator and Activity Director told him to “shut up,” “mind your business,” and “don’t say anything” after he complained that the festival was not just for residents. He stated that the Activity Director was joking but that the Administrator “meant it” and took it “to a whole new level.” He had not reported the allegation before that meeting. When Resident #1 voiced the allegation during the PASARR meeting, the MDS Nurse left the meeting and brought the Administrator into the room, explaining she believed the accused had the right to face their accuser. The Administrator, who was the alleged perpetrator and also the Abuse Coordinator, entered the meeting and directly engaged with Resident #1 about his allegation. Resident #1 reported that when he tried to speak, the Administrator repeatedly put her hand up to stop him from talking, and that she argued with him about what she had said. The ECC Service Coordinator, who was also present, stated that the Administrator negated the resident’s claim, said he was fabricating the allegation in retaliation, and argued back and forth with him. The Activity Director was not present at this meeting and was not confronted by the resident. The subsequent facility investigation, led by the DON with assistance from Corporate Staff, did not include an interview with Resident #1 and did not include a safe survey with him, despite his being the alleged victim. The DON acknowledged she did not interview the resident and instead relied on statements from the MDS Nurse and Administrator, as well as denials from the Administrator and Activity Director. She also did not interview other individuals who were present at the PASARR meeting, such as the Therapy Director or ECC Service Coordinator. Corporate Staff later stated he was unaware that the resident had not been interviewed and that other meeting participants had not been interviewed, and he acknowledged that failure to complete a thorough investigation could result in missed information. The facility’s abuse/neglect policy stated that all investigations of abuse would be investigated, but the investigation report for this allegation did not reflect that Resident #1 was interviewed or given a safe survey, and the DON stated she did not identify any issues with her investigation. The Administrator stated that facility staff were supposed to contact the DON or Corporate Staff if she was named as the alleged perpetrator, but in this case she personally went into the PASARR meeting and spoke with the resident about his allegation. The MDS Nurse later recognized that having a resident face the alleged perpetrator could cause fear of retaliation and make it feel unsafe to report concerns. Corporate Staff stated that the MDS Nurse should have notified the DON instead of bringing in the Administrator. Despite these circumstances, the investigation concluded the allegation was unfounded, without direct resident interview or comprehensive witness interviews, resulting in a failure to have evidence that the alleged violation was thoroughly investigated as required by facility policy. The DON characterized Resident #1 as a “fabricator of instances and stories” and stated he was care planned for this behavior, and she reported that both the Administrator and Activity Director denied the allegation. The Administrator reported that the resident had made multiple calls to the state in the past and was upset about not being allowed to sell items out of his room. However, these characterizations and prior behaviors were not balanced by a documented, direct interview with the resident about the specific allegation, nor by interviews with all individuals present at the PASARR meeting. The Provider Investigation Report did not document a resident interview or safe survey, and the DON admitted she was “probably supposed to interview the resident” but did not know what the policy required without reading it. As a result, the facility lacked documentation that it had thoroughly investigated the verbal abuse allegation in accordance with its abuse/neglect policy.
Failure to Document and Coordinate Dialysis Care
Penalty
Summary
The facility failed to ensure that residents requiring dialysis received services consistent with professional standards, their care plans, and their individual goals and preferences. Specifically, for three residents reviewed, there was inadequate documentation regarding offsite hemodialysis treatments at an ESRD unit. Record reviews revealed that care plans identified the need for regular dialysis and associated interventions, such as monitoring access sites and documenting post-dialysis weights and communication from the dialysis center. However, there were no active orders for dialysis treatment or care of dialysis access sites in the residents' records, and required documentation such as post-dialysis weights and communication forms from the dialysis center were missing for extended periods. Interviews with staff, including LVNs and the DON, confirmed that there was no consistent process for collecting and maintaining dialysis communication forms from the dialysis center. Staff reported that forms were sometimes lost or not returned, and there was no centralized system for tracking these documents. Additionally, the DON acknowledged that orders were not always reactivated when residents returned from the hospital, and the admitting nurse was responsible for ensuring orders were in place. The CNA responsible for pre- and post-dialysis weights indicated that her schedule did not always align with residents' return from dialysis, leading to missed documentation. Despite residents reporting that they attended all scheduled dialysis appointments and had no concerns about their care, the facility's records did not reflect adequate documentation of dialysis treatments, post-dialysis monitoring, or communication with the dialysis center. The lack of active orders and missing documentation could result in incomplete monitoring and care for residents receiving dialysis, as evidenced by the findings during the survey.
Deficient Food Storage and Handling Practices Identified in Kitchen
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. During an inspection of the kitchen's dry storage, refrigerator, and freezer areas, surveyors observed multiple food items that were unsealed and exposed to air, including containers of cream cheese icing, white rice, powder milk, a gallon of Caesar salad dressing, and several boxes of frozen foods. Additionally, expired food items were found in both the dry storage and refrigerator areas, such as a container of jalapeno peppers and a container of pickles. A dented can of lima beans was also found stored with other canned goods in the dry pantry area. Interviews with the Dietary Supervisor (DS) and dietary staff revealed that they were unaware of the presence of expired, unsealed, and dented food items in the kitchen. The DS stated that all kitchen staff were responsible for ensuring food items were sealed, labeled, and checked for expiration dates, and that dented cans should be removed from shelves and placed in a designated area. Staff interviews confirmed that they had received training on food storage, labeling, and the FIFO (First In, First Out) method, but were not aware of the deficiencies identified during the survey. A review of the facility's food storage policy indicated that all foods and supplies should be stored appropriately to protect them from contamination, with procedures for checking in and storing items, and ensuring older products are used first. The FDA Food Code was also referenced, requiring packaged food to be labeled and protected from contamination. Despite these policies and staff training, the facility did not ensure compliance, resulting in the presence of unsealed, expired, and dented food items in the kitchen.
Failure to Accurately Reconcile and Document Controlled Medication Administration
Penalty
Summary
The facility failed to establish and implement a consistent and accurate system for reconciling controlled medications, specifically Lorazepam 0.5mg, for a resident with a history of non-Alzheimer's dementia, hypertension, and senile degeneration of the brain who was on hospice care. The resident had physician orders for Lorazepam to be administered as needed for anxiety or agitation. During a surveyor's observation, the medication blister pack for Lorazepam was found to have two broken seals: one with the pill still inside and taped over, and another with the pill missing. The documented count was 12 pills, but only 11 were present in the blister pack. Interviews with nursing staff revealed that the nurse responsible for administering the medication did not notice the missing pill or the broken blister seals until it was brought to her attention by the surveyor. The nurse admitted to making a documentation error, initially recording that two pills were given instead of one, and later making a late entry to correct the mistake. The nurse also failed to sign the narcotic count sheet at the time of administration. The DON confirmed that facility policy requires any broken blister pack seal to result in the pill being discarded by two nurses, and that taping over a broken seal is not acceptable. However, this protocol was not followed in this instance. Further interviews with other nursing staff indicated that narcotic counts were performed at shift changes, but the broken blister and missing pill were not detected during these counts. The facility's policy on controlled substances outlines detailed procedures for handling, documenting, and reconciling controlled medications, but these procedures were not consistently followed, resulting in an inaccurate account of the controlled drug and a failure to maintain proper records of receipt and disposition.
Medication Storage Policy Not Followed
Penalty
Summary
A deficiency occurred when a resident was found to have a bottle of nystatin 100,000 units topical powder stored in her room, rather than in a locked medication or treatment cart as required by facility policy and professional standards. The resident, who is cognitively intact and has multiple medical diagnoses including hypertension, morbid obesity, hyperlipidemia, and COPD, kept the medication in her drawer and would either self-administer or request staff assistance for application. During a bed bath, the resident handed the medication to a CNA for application, revealing that the medication was not secured. Interviews with facility staff, including a CNA, an LVN, and the DON, confirmed that medications are to be stored in locked carts and that only nurses should apply medicated powders. The LVN and DON were unaware that the resident had medication in her room, and both acknowledged that this was against facility policy. Review of the facility's medication storage and labeling policy further confirmed that all medications must be stored in locked compartments and only accessed by authorized personnel.
Failure to Refer for PASRR Level II Evaluation After New Mental Health Diagnosis
Penalty
Summary
The facility failed to refer a resident for a Level II PASRR Evaluation after the resident received a new diagnosis of bipolar disorder. Initially, the resident's PASRR Level I Screening did not indicate the presence of a mental illness, intellectual disability, or developmental disability, and therefore, a Level II Evaluation was not completed at that time. However, after the resident was later diagnosed with bipolar disorder, there was no evidence in the medical record that a subsequent PASRR Screening or Evaluation was conducted as required. The resident in question was an older female admitted with multiple diagnoses, including sick sinus syndrome, heart failure, and, later, bipolar disorder. The MDS Assessment confirmed the bipolar disorder diagnosis, but the facility did not initiate the necessary PASRR Level II Evaluation following this new diagnosis. The MDS Coordinator acknowledged that the evaluation should have been completed and was unable to provide a reason for the omission, as she was not employed at the facility during that period. Additionally, the facility did not have a policy related to PASRR Evaluations and relied on following state guidelines.
Failure to Use PPE During High-Contact Care for Resident on Enhanced Barrier Precautions
Penalty
Summary
A deficiency was identified when LVN B failed to don personal protective equipment (PPE) prior to performing a high-contact care activity for a resident on enhanced barrier precautions. Specifically, LVN B prepared and administered medication and tube feeding to a male resident with a history of bipolar disorder, hemiplegia, dysphagia, and gastronomy status, without wearing the required PPE. The resident's care plan and room signage indicated the need for enhanced barrier precautions, and a PPE cart was available outside the room. Despite this, LVN B only performed hand hygiene before entering the room and did not use gloves or a gown while accessing the resident's feeding tube. During interviews, LVN B acknowledged awareness of the resident's precaution status and admitted she should have donned PPE before providing care. She also recognized that failure to use PPE could put the resident at risk for infection. The DON confirmed that staff were expected to use appropriate PPE for residents on enhanced barrier precautions and that staff had been in-serviced on infection control protocols. Facility policy required the use of gloves and gowns for high-contact activities, including device care such as feeding tubes, but this protocol was not followed in this instance.
Failure to Report Alleged Abuse in a Timely Manner
Penalty
Summary
The facility failed to report an allegation of abuse involving a resident and a staff member, LVN A, in a timely manner as required by Texas law. The incident involved a resident who accused LVN A of punching her on the shoulder. Despite being aware of the allegation, LVN A did not report it to the facility's abuse coordinator or the Administrator. This failure to report the incident placed residents at risk of ongoing abuse and potential harm. The resident involved in the incident was an elderly female with a history of dementia, bipolar disorder, anxiety disorder, and paranoid personality disorder. She had a BIMS score indicating intact cognition and required assistance with daily activities. The resident had a history of verbally abusive behaviors and had been involved in a resident-to-resident altercation, leading to a recommended discharge from the facility. Despite these behaviors, the allegation of abuse by LVN A was not documented in the resident's progress notes or the facility's incident log. Interviews with facility staff, including LVN A, the DON, the Administrator, and the Owner, revealed a lack of awareness and action regarding the abuse allegation. LVN A admitted to not reporting the incident and was unable to define abuse and neglect during the interview. The DON and Administrator were unaware of the allegation until informed by a State Surveyor. The facility's policy required immediate reporting and investigation of abuse allegations, but this protocol was not followed, resulting in a deficiency in the facility's handling of the situation.
Infection Control Deficiencies
Penalty
Summary
The facility failed to maintain an infection prevention and control program, leading to multiple instances of non-compliance with infection control protocols. For Resident #21, a CMA did not perform hand hygiene before and after checking the resident's blood pressure and administering medication. This lapse in protocol was acknowledged by the CMA, who admitted to forgetting to perform hand hygiene, thereby risking the spread of infection to the resident, who has multiple health issues including stroke, high blood pressure, and diabetes. For Resident #35, who was on contact isolation for C-diff, a CNA failed to follow proper infection control procedures during incontinent care. The CNA used dirty gloves to retrieve and apply barrier cream from her pocket, contaminating both herself and the resident. The CNA admitted to being aware of the isolation precautions but failed to change gloves or perform hand hygiene, thereby risking the spread of infection. Additional deficiencies were observed with Resident #38 and Resident #48, where LVNs failed to perform hand hygiene and change gloves during medication administration and blood sugar checks, respectively. The medication rooms were also found to be in unsanitary conditions, with personal belongings and unclean surfaces, further risking contamination. Interviews with staff and administration revealed a lack of adherence to infection control policies, despite ongoing training and in-services on the subject.
Fly Infestation in Facility
Penalty
Summary
The facility failed to maintain an effective pest control program, resulting in a significant fly infestation in two hallways (F and H). Multiple residents reported and were observed to be affected by the flies, which were seen landing on their skin, clothing, and personal items. Residents expressed frustration and concern about the unsanitary conditions, with some even resorting to using their own fly swatters. The issue was particularly noticeable in the dining room and courtyard, where flies were observed to be a persistent problem. Interviews with residents and staff revealed that the fly problem had been ongoing, especially during warmer weather. Residents had repeatedly raised their concerns with the Administrator and Maintenance Supervisor, but no effective solutions had been implemented. Staff members acknowledged the presence of flies and attributed it to residents keeping juice and fruit in their rooms, as well as the proximity of horse stables to the facility. Despite the use of blue light traps and monthly pest control visits, the problem persisted. The Maintenance Director, who was new to the facility, confirmed that pest control services were conducted monthly and that additional measures were being considered. However, the Administrator and Maintenance Director both cited the nearby horse stables as a significant source of the fly infestation. The facility's Pest Control Policy indicated that frequent treatment and additional visits should be conducted when a problem is detected, but these measures had not been effective in resolving the issue. Residents continued to experience discomfort and unsanitary conditions due to the persistent fly problem.
Failure to Provide Adequate Grooming and Personal Hygiene
Penalty
Summary
The facility failed to provide necessary services to maintain good grooming and personal hygiene for two residents who were unable to perform activities of daily living (ADLs) independently. Resident #38, who had diagnoses including cerebral infarction, anxiety disorder, aphasia, and hemiplegia, was observed with long fingernails despite his family member's request to the nursing staff to have them trimmed. The resident's BIMS score indicated significant memory problems, and he was rarely or never understood, requiring modified independence in decision-making regarding daily tasks. The family member confirmed that the staff had not trimmed the resident's fingernails despite multiple requests. Resident #33, who had diagnoses including acute and chronic respiratory failure, atrial fibrillation, and pulmonary hypertension, was observed with an unkempt beard, flaky skin, and long, dirty fingernails and toenails. The resident, who had a BIMS score indicating no memory problems and was independent in decision-making, reported that he had requested nail care from the nursing staff two weeks prior, but no action had been taken. Interviews with the ADON, CNA, DON, and Administrator revealed inconsistencies and lack of clarity in the facility's nail care procedures, contributing to the observed deficiencies in personal hygiene and grooming for these residents.
Medication Storage and Lighting Deficiencies
Penalty
Summary
The facility failed to implement procedures for the safe storage and handling of medications in two medication rooms. Specifically, the refrigerator in one medication room was found to be at 56 degrees Fahrenheit, which is outside the safe temperature range for storing medications. The refrigerator contained unopened and unexpired insulin vials, insulin pens, vaccines, suppository medications, and cold packs. The refrigerator door insulation was partially torn off, and the staff responsible for monitoring the temperature logs were unaware of the correct temperature range. Additionally, the lighting in the medication rooms was inadequate, with multiple ceiling lights not functioning, which was not noticed by the staff until pointed out by the surveyors. The ADON and Maintenance Director were also unaware of the proper temperature range and the status of the medication rooms, respectively. Interviews with the RN, ADON, Maintenance Director, DON, and Administrator revealed a lack of awareness and communication regarding the proper storage conditions for medications. The night shift nursing staff was responsible for monitoring and documenting refrigerator temperatures, but there was no clear understanding of the acceptable temperature range or the risks associated with improper storage. The facility's policy on medication labeling and storage did not address the issue of lighting in the medication rooms, and the DON stated that there was no risk with lighting as the medication room was not used for preparing medications. The Administrator emphasized the importance of following facility policies and procedures to prevent the spread of infection.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Fort Worth
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Village Creek Nursing & Rehabilitation | 0.6 mi | ★★★★★ | 11 | 0 |
| Tuskegee Airmen Texas State Veterans Home | 3.3 mi | — | 11 | 3 |
| Green Oaks Nursing & Rehabilitation | 3.4 mi | ★★★★★ | 1 | 0 |
| Park View Care Center | 3.7 mi | ★★★★★ | 24 | 0 |
| Avir At Kennedale | 4.2 mi | ★★★★★ | 25 | 2 |
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