Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around December 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Good Samaritan Society - International Falls during CMS and state inspections, most recent first.
A resident with severe cognitive impairment and dependence on staff for personal hygiene did not have their shaving preferences assessed or documented. Staff only provided shaving on bath days or upon request, and the care plan did not address the resident's grooming preferences, despite family input that daily shaving was preferred. Facility policy required grooming services based on assessment, but this was not reflected in the resident's records.
A resident with multiple diagnoses, including anemia and long-term anticoagulant use, had an abnormally high ferritin level identified in lab results. Facility staff did not document the lab draw or results in the medical record, nor was there evidence that the provider was notified of the abnormal finding, despite facility policy requiring timely reporting of such results.
Staff did not perform required hand hygiene after providing perineal care and handling bodily fluids for two residents who needed substantial assistance with ADLs. In both cases, staff failed to wash hands or use sanitizer after glove removal and before moving to another resident, despite facility policy and staff awareness of proper procedures.
The facility's assessment failed to include specific staffing levels for different shifts and did not identify residents requiring oxygen supplementation or those with PTSD. The current administrator had not reviewed the assessment completed by the previous administrator, and a policy on the facility assessment was not provided.
The facility failed to develop action plans for identified monitoring areas and did not implement any process improvement projects (PIPs), potentially affecting all 50 residents. Meeting minutes showed reviews of various topics, but no action plans with measurable goals were documented. The RN responsible for the QAPI program was unfamiliar with PIPs, and the DON was unaware of the lack of PIPs. The facility's policy required at least one PIP annually, focusing on high-risk or problem-prone areas.
The facility failed to implement an effective infection control program, including inadequate tracking and reporting of infections, and did not conduct COVID-19 testing per CDC guidelines. Enhanced barrier precautions were not implemented for a resident with pressure ulcers, and a nurse did not wear a mask during a PICC line dressing change. The facility's system for tracking illness and testing was inadequate, leading to a system failure in preventing illness transmission.
A resident with paraplegia and autonomic dysreflexia was left without a functional motorized wheelchair after a lightning strike, despite the facility's knowledge of the issue. The resident's care plan required the use of a motorized wheelchair for independence, but the facility failed to repair it, leaving the resident with an unsuitable manual wheelchair. Staff interviews revealed a lack of communication and follow-up, and the facility did not adhere to its policy on accommodating resident needs.
A facility failed to accurately code medications on the MDS for a resident with severe cognitive impairment and multiple diagnoses. The resident was incorrectly documented as receiving an antianxiety medication, while the MAR indicated they were receiving Trazodone, an antidepressant, for anxiety-related symptoms. An RN admitted to reviewing medications by their use rather than class, leading to the error. The DON expected the MDS to be accurate for comprehensive care planning.
A resident with severe cognitive impairment and incontinence was not provided necessary assistance with toileting and repositioning over a period of several hours. Despite multiple staff interactions, the resident was not checked for incontinence or repositioned according to the care plan, which required checks every two hours. The resident was observed in a slouched position with the call light on for an extended period before staff finally attended to her.
A resident with severe cognitive impairment and a stage two pressure ulcer was not repositioned as required by their care plan, despite being at risk for further ulcer development. During a period of observation, the resident remained in the same position for over two hours, with multiple staff entering the room but failing to reposition them. The facility's policy required repositioning every two hours, which was not followed.
A facility failed to provide trauma-informed care for a resident with PTSD, who exhibited aggressive behaviors and had a history of serving in the Vietnam War. The care plan lacked individualized interventions and did not identify potential triggers, contrary to the facility's policy requiring a trauma assessment within five days of admission.
The facility failed to ensure proper monitoring of high-risk and psychotropic medications for two residents. One resident, with cognitive impairment and behavioral issues, was not monitored for adverse effects of antidepressant and chemotherapy medications. Another resident, on multiple medications, lacked evidence of necessary blood work to assess treatment effectiveness. Interviews revealed a lack of documentation and consideration of pharmacist recommendations, despite facility policies requiring regular monitoring.
The facility failed to monitor adverse effects of high-risk medications for two residents. One resident, with chronic myeloid leukemia, received Gleevec without documented monitoring for side effects. Another resident, with multiple diagnoses, was on anticoagulant and diuretic medications without evidence of monitoring or annual lab work. The facility's policy to monitor high-risk medications every shift was not followed.
The facility failed to monitor adverse effects and behaviors related to psychotropic medication use for two residents. One resident with cognitive impairment and behavioral issues was not monitored for side effects of antidepressants, while another resident on lorazepam and Lexapro was not monitored for adverse effects or behavioral symptoms. The facility's policy required monitoring, but errors in order entry and staffing issues led to non-compliance.
A facility failed to label insulin pens with a resident's name, as required for drugs and biologicals. An LPN administered Humalog and Toujeo insulin to a Type 2 diabetic resident without labeled pens, relying on the fact that the resident was the only diabetic on the unit. Interviews revealed that the pens should have been labeled by the pharmacy or staff, and the RN noted the infection control issue and the resident's right to labeled medication. The facility's policy mandates labeling with specific information, including the resident's name.
A facility failed to establish a process for antibiotic review for a resident with renal insufficiency, diabetes, Alzheimer's, and dementia. The resident was prescribed cefdinir for a UTI with hematuria, but the urine culture showed mixed microflora, suggesting contamination. The facility used McGreer Criteria for antibiotic use, but there was confusion about actions at the unit level and communication issues with ED providers who frequently prescribed antibiotics inappropriately.
The facility failed to post accurate and timely nurse staffing information, with outdated postings and missing dates. Staff were unaware of the requirement to update postings for call-ins and shortages, and the facility lacked a policy on nurse staff postings.
Failure to Assess and Provide Shaving Preferences for Dependent Resident
Penalty
Summary
The facility failed to assess and provide for the shaving preferences of a resident with severe cognitive impairment and multiple diagnoses, including dementia and a traumatic brain injury. The resident required substantial to maximal assistance for personal hygiene, yet his medical record did not contain documentation of his shaving preferences. The care plan, while addressing the need for assistance with ADLs due to physical and cognitive limitations, did not specify shaving preferences. Observations revealed that the resident had significant beard growth and was not offered shaving assistance during care routines. Interviews with staff indicated that shaving was typically performed only on bath days or upon resident request, and if a resident was unable to request, shaving was not routinely provided outside of scheduled bath days. A family member reported that the resident had previously shaved daily and expressed difficulty in getting staff to maintain this routine. The facility's policy required necessary services to maintain grooming based on comprehensive assessment, but there was no evidence in the medical record to support that the resident's shaving preferences were assessed or addressed.
Failure to Notify Provider of Abnormal Lab Result
Penalty
Summary
The facility failed to promptly notify the primary care provider of an abnormal laboratory result for one resident who was cognitively intact and required significant assistance with daily activities. The resident had diagnoses including atrial fibrillation, anemia, depression, long-term use of anticoagulants, and dysphagia. Orders were in place for annual blood tests, including a comprehensive blood count, basic metabolic panel, thyroid stimulating hormone, prothrombin time, and ferritin level. The medical record did not contain documentation of the lab work being drawn or the results, despite the resident receiving iron supplementation for anemia. Laboratory results from November showed an abnormally high ferritin level, but there was no documentation in the resident's progress notes or provider visit notes indicating that the results were reviewed or that the provider was notified. Interviews with nursing staff and the DON revealed that it was not the facility's practice to document labs drawn or lab results in the resident charts, and that nurse managers were responsible for reviewing and scanning lab results into the medical record. However, it was acknowledged that it would be difficult to determine if results had been reviewed or if the provider had been notified of abnormal findings. The facility's policy required timely reporting of lab findings to the ordering provider, but this was not followed in the case of the resident's elevated ferritin level, as there was no evidence of provider notification or review.
Failure to Perform Hand Hygiene After Personal Care
Penalty
Summary
Staff failed to perform appropriate hand hygiene during and after providing personal care to two residents requiring substantial or maximal assistance with activities of daily living (ADLs). One resident with severe cognitive impairment, dementia, and a traumatic brain injury required assistance with personal hygiene and toileting, including the use of a mechanical lift and catheter care. During observed care, staff donned gowns, gloves, and masks but did not use hand sanitizer before gloving. After performing perineal care and handling bodily fluids, staff continued to wear the same gloves, did not perform hand hygiene after glove removal, and exited the resident's room without washing hands or using hand sanitizer. In a separate instance, staff entered another resident's room—who had left-sided hemiplegia and required assistance with toileting—without performing hand hygiene. The staff member applied gloves, assisted with perineal care, and then removed gloves without washing hands or using hand sanitizer before leaving the room. Interviews with staff confirmed awareness of the hand hygiene requirements, and facility policy mandated hand hygiene at specific moments, including after glove removal and before entering another resident's room. These actions and inactions directly led to the identified deficiency in infection prevention and control.
Facility Assessment Lacks Staffing and Resource Details
Penalty
Summary
The facility failed to review and update its facility-wide assessment to incorporate minimal staff requirements and all necessary resources and conditions to care for the resident population. The assessment, dated on an unspecified date, identified the need to determine resources necessary for competent care during both day-to-day operations and emergencies. However, it did not include specific staffing levels needed for different shifts based on resident population and acuity. Additionally, the assessment did not identify residents requiring oxygen supplementation or the minimal equipment and supplies needed for their care. It also lacked an assessment of the resident population with a diagnosis of PTSD. During an interview, the current administrator admitted that the facility assessment was completed by the previous administrator and had not been reviewed by him. He stated that minimum staffing was based on the facility census, with a bare minimum of one nurse and aide on each wing during the day and evening shifts, and one aide on each wing with a nurse float for the overnight shift. The administrator was unsure about the level of detail required for documenting oxygen needs in the assessment but acknowledged that PTSD should be covered. Furthermore, a policy on the facility assessment was required but was not provided.
Failure to Develop Action Plans and Implement PIPs
Penalty
Summary
The facility failed to develop action plans for identified areas of monitoring and did not implement at least one process improvement project (PIP), which had the potential to affect all 50 residents. The Quality Assurance, Action Committee Meeting Minutes from various dates showed that the team reviewed several topics, including infection control, emergency operation plans, dietary concerns, and more. However, the data did not show any facility-developed and implemented action plans with measurable goals or actions taken. Additionally, the facility could not provide evidence of any PIP project focusing on high-risk or problem-prone areas identified through data collection and analysis. Interviews revealed that the registered nurse responsible for the facility's QAPI program had not fully addressed the facility's response to a recent COVID-19 outbreak and was unfamiliar with PIPs. The director of nursing was unaware that no PIPs were in place and stated that there should be performance improvement projects. The facility's Quality Assurance and Performance Improvement policy required at least one PIP to be in development, ongoing, or completed annually, focusing on high-risk, high-volume, or problem-prone areas. The QAPI committee was responsible for tracking and analyzing quality deficiencies, developing action plans, and monitoring effectiveness and sustainability.
Inadequate Infection Control and COVID-19 Testing in LTC Facility
Penalty
Summary
The facility failed to develop and implement an effective infection control surveillance plan, which included identifying, tracking, monitoring, and reporting infections and communicable diseases. The reports for several months did not adequately document whether infections were treated, nor did they identify residents with symptoms of viral infections other than COVID-19. The facility's antimicrobial usage rate was higher than the enterprise average, and there was no written summary of the analysis of actual or potential infections. Additionally, the facility did not have a policy related to infection surveillance, tracking, and trending. The facility also failed to conduct COVID-19 testing of staff and residents according to CDC guidelines. There was a lack of documentation and tracking of staff testing, with several staff members not testing according to the guidelines during a COVID-19 outbreak. The facility did not maintain a COVID-19 Testing Roster for residents, and there was no documentation of when residents were placed into transmission-based precautions. The facility's system for tracking staff and resident illness and testing was inadequate, leading to a system failure in preventing the transmission of illness. Furthermore, the facility did not implement enhanced barrier precautions (EBP) for a resident with pressure ulcers and failed to wear a mask during a peripherally inserted central catheter (PICC) line dressing change for another resident. The infection preventionist did not require EBP for the resident with chronic wounds, and staff were not informed when EBP was needed. During a PICC line dressing change, a nurse did not wear a mask, and another nurse assisting was not trained on the procedure, which was against the facility's policy for sterile technique during such procedures.
Failure to Maintain Resident's Motorized Wheelchair
Penalty
Summary
The facility failed to maintain an electric wheelchair in working order for a resident with paraplegia and autonomic dysreflexia, who relied on the motorized wheelchair for independent mobility. The resident's motorized wheelchair became non-functional after a lightning strike hit the facility, and despite being reported to maintenance, no effective action was taken to repair it. The resident was left with a manual wheelchair that was uncomfortable and did not meet his needs, particularly during autonomic dysreflexia episodes when he needed to recline immediately. Interviews with staff revealed a lack of communication and follow-up regarding the wheelchair's repair. The maintenance staff was aware of the issue but did not take appropriate steps to resolve it, and the director of nursing was unaware of the problem. The facility's policy on accommodating resident needs was not adhered to, as there was no evidence of assessment or discussion with the resident about the broken wheelchair. The resident's care plan emphasized the importance of the motorized wheelchair for maintaining independence, yet the facility did not ensure its functionality.
Inaccurate Medication Coding on MDS
Penalty
Summary
The facility failed to ensure accurate coding of medications on the Minimum Data Set (MDS) for a resident reviewed for unnecessary medications. The resident, who had severe cognitive impairment and diagnoses including Alzheimer's, non-Alzheimer's dementia, diabetes, and depression, was identified on the MDS as receiving an antianxiety medication. However, the medication administration report (MAR) for October 2024 showed the resident was receiving Trazodone, an antidepressant, for generalized anxiety disorder, restlessness, and agitation. During an interview, a registered nurse (RN) responsible for the MDS admitted to reviewing medications based on their use rather than their class, leading to the incorrect entry of the antidepressant as an antianxiety medication. The director of nursing (DON) expressed the expectation that the MDS should be complete and accurate to provide a comprehensive picture of the resident's care needs.
Failure to Assist Resident with Toileting and Repositioning
Penalty
Summary
The facility failed to provide necessary assistance with toileting for a resident, identified as R203, who was dependent on staff for activities of daily living. R203 had severe cognitive impairment, was bedfast, and was always incontinent of bowel and bladder. The care plan required staff to check and change R203 every two hours and as needed. However, during a continuous observation period from 4:30 p.m. to 7:10 p.m., R203 was not checked for incontinence despite multiple staff interactions. Nursing assistant NA-N and LPN-C entered the room at different times but did not check R203 for incontinence or reposition her, even though the resident's call light was on for an extended period. R203 was observed in a slouched position in bed, with her head hanging to the right side and her chin on her chest, indicating a lack of repositioning. The call light remained on from 5:57 p.m. until 7:06 p.m., when NA-M and NA-N finally entered the room, lowered the head of the bed, and checked R203 for incontinence, finding her dry. Interviews with staff revealed that they were aware of the requirement to check and change R203 every two hours, but this was not adhered to during the observation period. The director of nursing confirmed that the facility's expectation was for staff to follow the care plan directives.
Failure to Reposition Resident at Risk for Pressure Ulcers
Penalty
Summary
The facility failed to provide timely repositioning for a resident identified as R203, who was at risk for pressure ulcer development and had a stage two unhealed pressure ulcer upon admission. R203 required substantial to maximum assistance with mobility and was dependent on staff for toileting and transfers. The care plan directed staff to turn and reposition R203 every two hours and as needed, but during an observation period from 4:30 p.m. to 7:10 p.m., R203 was not repositioned despite multiple staff interactions. R203 remained in the same position, slouched in bed with her head hanging to the side, and the call light was on for an extended period without response. Staff members, including a homemaker and an LPN, entered the room but did not attempt to reposition R203. It was not until 7:06 p.m. that two nursing assistants entered the room, noticed R203's precarious position, and repositioned her. The director of nursing later confirmed that the facility's expectation was for staff to check and change residents every two hours if directed by the care plan. The facility's policy on Activities of Daily Living also required necessary services to maintain residents' well-being, which was not adhered to in this instance.
Failure to Provide Trauma-Informed Care for Resident with PTSD
Penalty
Summary
The facility failed to comprehensively assess and care plan for trauma-informed care for a resident with a history of trauma, specifically post-traumatic stress disorder (PTSD). The resident, who had moderate cognitive impairment, exhibited behaviors such as verbal and physical aggression, and rejection of care. Despite having a care plan that addressed some behavioral symptoms, it lacked individualized trauma-informed approaches or interventions and did not identify potential triggers to avoid re-traumatization. The resident's medical record also lacked a comprehensive assessment for PTSD, potential triggers, and interventions. Interviews with staff and family members revealed that the resident had served in the Vietnam War and had a career as a fire chief, with experiences that could potentially trigger PTSD symptoms. Staff noted that the resident would become angry if others mentioned military service without having served in war. The facility's policy required a trauma assessment within five days of admission, but this was not completed for the resident. The director of nursing acknowledged the importance of assessing and care planning for PTSD to alert staff to potential triggers.
Failure to Monitor High-Risk and Psychotropic Medications
Penalty
Summary
The facility failed to ensure that the consulting pharmacist identified and communicated the need for monitoring potential adverse events for high-risk medications for two residents. One resident, who had moderate cognitive impairment and exhibited behavioral issues, was receiving antidepressant and chemotherapy medications. The medical record lacked evidence of monitoring for adverse effects as ordered by the physician. The consulting pharmacist had recommended adjustments to the resident's medication regimen but did not identify the need for monitoring psychotropic medication side effects. Another resident, with intact cognition and no behavioral symptoms, was on antidepressant, anticoagulant, and diuretic medications. The medical record lacked evidence of annual blood work to assess the effectiveness of hyperthyroid treatment and monitor therapeutic dosages. The consulting pharmacist had recommended a review of the resident's medications, but the physician refused the recommendation. The pharmacy reviews did not show evidence of recommendations for monitoring psychotropic medication side effects or adverse behaviors. Interviews with facility staff revealed that there was a practice to monitor high-risk and psychotropic medications every shift, but documentation was lacking. The consulting pharmacist stated that they checked for side effects and behavior monitoring during monthly reviews but felt that recommendations were not considered. The facility's policy required regular pharmacist services, but the pharmacist noted that recommendations for lab work were not made, and the facility had been short-staffed, affecting the monitoring process.
Failure to Monitor Adverse Effects of High-Risk Medications
Penalty
Summary
The facility failed to ensure proper monitoring for adverse events related to high-risk medications for two residents. One resident, with moderate cognitive impairment and diagnosed with chronic myeloid leukemia and dementia, was prescribed Gleevec. Although the medication was administered daily as ordered, there was no evidence in the Medication Administration Record (MAR) or Treatment Administration Record (TAR) of monitoring for side effects as required. The registered nurse acknowledged the oversight, noting that the order to monitor for side effects was not correctly transferred to the MAR or TAR, and lab work was often missed due to reliance on primary physicians to order it. Another resident, with intact cognition and diagnosed with chronic obstructive pulmonary disease, atrial fibrillation, and kidney disease, was on anticoagulant and diuretic medications. Despite receiving these medications daily, the MAR and TAR lacked documentation of monitoring for adverse effects. Additionally, there was no evidence of annual lab work to assess the effectiveness and therapeutic levels of the medications. The registered nurse and consultant pharmacist both recognized the need for routine lab work, which had not been conducted, and the facility's policy to monitor high-risk medications every shift was not followed.
Failure to Monitor Adverse Effects of Psychotropic Medications
Penalty
Summary
The facility failed to ensure proper monitoring for adverse events and behaviors related to psychotropic medication use for two residents. One resident, identified as R22, had moderate cognitive impairment and exhibited behaviors such as verbal and physical abuse, as well as care rejection. Despite receiving daily antidepressant medication, the facility did not document monitoring for adverse effects as ordered by the physician. The Medication Administration Record (MAR) and Treatment Administration Record (TAR) lacked evidence of monitoring for side effects, which was confirmed by a registered nurse who noted an error in the order entry process. Another resident, R37, who had intact cognition and no identified behavioral symptoms, was also not monitored for adverse effects of their psychotropic medications. The resident received daily doses of lorazepam and Lexapro, but the MAR and TAR did not reflect any monitoring for adverse effects or behavioral symptoms. The director of nursing and a registered nurse confirmed that the facility's practice was to monitor psychotropic medications every shift, which was not done in this case. The consultant pharmacist acknowledged the oversight in monitoring and noted that the facility had been short-staffed, which affected their ability to conduct monthly behavior monitoring meetings. The facility's policy required continuous documentation of mood and behavior to monitor the effects of psychotropic medications, but this was not adhered to for the residents in question. The pharmacist had planned to review the residents' charts but had not yet made specific recommendations for monitoring side effects or adverse behaviors.
Unlabeled Insulin Pens for Diabetic Resident
Penalty
Summary
The facility failed to ensure that two insulin pens were labeled with the resident's name, which is a requirement for drugs and biologicals used in the facility. This deficiency was observed during the administration of insulin to a resident identified as R154, who was a Type 2 diabetic. The insulin pens, Humalog and Toujeo, were not labeled with the resident's name, although the boxes they came in were labeled and stored in the fridge in the medication room. The LPN administering the medication knew the pens belonged to R154 because they were the only diabetic resident on the unit receiving injectable medication. Interviews with the LPN and RN revealed that the pens should have been labeled either by the pharmacy or by the staff with a sticker containing the resident's information. The RN acknowledged that an unlabeled medication pen posed an infection control issue and noted that the resident had paid for the medication, which should have been labeled with their name. The facility's policy on medication labeling requires each prescription medication to be labeled with specific information, including the resident's name, which was not adhered to in this case.
Failure to Establish Antibiotic Review Process
Penalty
Summary
The facility failed to establish a process for antibiotic review to determine appropriate indications for use of an antibiotic for a resident reviewed for antibiotic use. The resident, who had diagnoses including renal insufficiency, diabetes, Alzheimer's disease, and dementia, was identified with a urinary tract infection (UTI) with symptoms of gross hematuria and flank pain related to kidney stones. However, the facility's report did not specify if the resident was treated with an antibiotic or if a urinalysis or urine culture were obtained. The resident was prescribed cefdinir for acute cystitis with hematuria, but the urine culture later identified mixed microflora, indicating possible contamination rather than infection. The registered nurse responsible for the infection control program stated that the facility used McGreer Criteria to determine if an antibiotic was warranted, but noted that the criteria were stringent and residents often had severe infections by the time they met the criteria. The facility reviewed antibiotic orders during morning meetings, but there was a lack of clarity on the actions taken at the unit level. The nurse expressed concerns about the emergency department (ED) providers who frequently prescribed antibiotics for conditions not typically treated with them, such as kidney stones, and mentioned that discussions with the medical director about these concerns had not progressed. The director of nursing acknowledged that antibiotic stewardship was reviewed on a case-by-case basis, but highlighted difficulties in communicating with ED providers due to their rotating schedules. The facility's policy indicated that McGreer Criteria should be used to determine appropriate antibiotic treatment, and in cases of contaminated urine samples, another sample should be collected to potentially stop antibiotic treatment. However, there was no follow-up to determine if the antibiotic should have been discontinued when the resident returned from the ED.
Failure to Maintain Accurate and Timely Nurse Staffing Postings
Penalty
Summary
The facility failed to consistently post accurate nurse staffing information daily, as required. During an observation, it was noted that the staff posting was outdated, showing a date from several days prior, and did not reflect actual staff working hours due to call-ins, vacations, or staff shortages. The facility was unable to provide an updated working staff schedule that accounted for these changes. Additionally, there were several dates where the nurse staff postings were missing entirely, and the postings did not indicate if any corrections had been made to reflect staffing changes. Interviews with facility staff revealed a lack of awareness and understanding of the requirements for nurse staff postings. The household coordinator, responsible for the staff schedule and postings, admitted to not updating the postings to reflect changes and was unsure of the retention period for these records. The DON confirmed that the postings should be retained for 18 months and updated daily but was unaware that they should reflect actual working staff changes. The administrator expected the census to be recorded and posted daily, but a policy regarding the nurse staff posting was not provided.
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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 International Falls
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| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Littlefork Care Center | 13.9 mi | — | 12 | 0 |
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