Initial Comments:
Based on the findings of an on-site unannounced Medicare recertification survey completed on 10/10/2024, Vantage Physical Therapy & Rehabilitation was found to have the following standard level deficiency that was determined to be in substantial compliance with the following requirements of 42 CFR, Part 485.727, Subpart H, Conditions of Participation for Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services - Emergency Preparedness. The survey was conducted at 311 Warren St Johnstown, PA the parent location on 9/26/2024, and two (2) branch locations located at 409 Bridge St Seward, PA and 1761 Goucher St Johnstown, PA.
Plan of Correction:
485.727(a)(4) STANDARD
Clinic Location- Use of Alarms and Fire
Name - Component - 00
§485.727(a)(4) Condition for Participation:
[(a) Emergency Plan. The Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services ("Organizations") must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following:]
(4) Address the location and use of alarm systems and signals; and methods of containing fire.
Observations:
Based on review of facility policy, documentation, and staff (EMP) interviews, the facility failed to implement preventive steps for containing fire based on the emergency preparedness plan for one (1) of three (3) agency sites observed (OBV1).
Findings included:
Review of the facility documentation was conducted on 9/27/2024 at approximately 11:30 AM which revealed, "Emergency Preparedness...Fire Prevention...The first step in our fire plan is for staff to take steps to prevent a fire. The following actions will be undertaken...6. To prevent storage containers, including trash from becoming a fire hazard following procedures will be followed ...b. Combustible items are stored away from heat producing appliances..."
A review of the safety data sheet on 9/27/2024 at approximately 10:20 PM revealed, "Product Identifier Zappit 73 ...Company Name Westlake Corporation ...Storge Store in a well-ventilated place, Keep container tightly closed, Store locked up ...7. Handling and storage Precaution for safe handling...Observe good industrial hygiene practices. Do not mix this product with any other chemicals, including any other pool chemicals of any kind, such as other disinfection or "shock" pool products. Contamination with moisture, acids, organic matter other chemicals (including , but not limited to cleaning chemicals and other pool chemicals), petroleum or paint products or other easily combustible materials may start a chemical reaction with generation of heat, liberation of hazardous gases and possible violent reaction leading to fire or explosion. Always add product to large quantities of water to fully dissolve product. Do not pour water into product, always add product to water. Do not use with stabilized chlorine or bromine tablet chemical feeders. Do not add this product to any dispensing device containing remnants of any other product or pool chemical. Conditions for safe storage, including any incompatibilities, Sore locked up. Keep away from heat. Store in a cool, dry place out of direct sunlight. Store in tightly closed container. Store in a well-ventilated place. Do not store near combustible materials. Store away from incompatible materials..."
Surveyors conducted an onsite visit (OBV1) at the agency's extension site located at 409 Bridge St Seward PA on 9/26/2024 starting at approximately 9:28 AM. Direct observation of agency's patient treatment revealed an aquatic therapy pool. Next to the pool were three containers stacked on top of each other. The top container was listed "POOL Brite pH PLUS" the middle container was labeled "ZAPPIT 73" and the bottom container was labeled "POOL Brite CALCIUM BOOSTER..."
During an interview with EMP4 on 9/26/2024 at approximately 1:18 PM the surveyor made EMP4 aware of the EPA warning label of one of the pool products. The surveyor showed EMP4 of a picture of the materials and their location. EMP4 stated that EMP6 would be contacted and made aware of the situation.
An exit interview with the director of operations was conducted on 9/30/2024 at approximately 10:45 PM which confirmed the above findings.
Plan of Correction:Plan of Correction for Deficiency: 485.727(a)(4) – Use of Alarms and Fire Prevention
Step 1: Correcting the Deficiency as It Relates to the Individual Site (OBV1)
- Action:
o Immediately relocate the combustible pool chemicals (ZAPPIT 73, POOL Brite pH PLUS, POOL Brite CALCIUM BOOSTER) from the area near the aquatic therapy pool to a properly ventilated, cool, dry, and fire-safe storage location.
o Ensure the chemicals are stored separately to prevent hazardous reactions and follow all manufacturer instructions regarding storage.
o Conduct an immediate inspection of the storage and handling of all chemicals at the facility to ensure compliance with fire safety protocols.
- Responsible Staff:
o The facility manager at the site will oversee the immediate relocation and correction of the hazardous materials.
o Director of Operations will conduct the inspection and ensure compliance with safety protocols.
- Completion Date: Immediate relocation of chemicals.
Step 2: Protecting Other Patients and Locations in Similar Situations
- Action:
o Conduct a facility-wide review of all storage practices involving hazardous or combustible materials, ensuring they meet safety guidelines.
o Ensure that all extension sites and any areas with similar storage setups are inspected within 1 week.
o Implement additional signage and warning labels for all hazardous material storage areas to ensure proper handling.
o Store chemicals with appropriate Material Data Sheets for reference in case of exposure.
o Update the emergency preparedness plan to reflect specific protocols regarding chemical storage and fire prevention.
- Staff Training:
o All staff members handling or managing storage will undergo training on fire safety, chemical handling, and emergency preparedness. The training will include identifying fire hazards and proper storage practices based on EPA and OSHA guidelines.
Step 3: Systems and Measures to Prevent Recurrence
- Action:
o Update the facility's emergency preparedness plan to include specific guidelines for chemical storage, including location, ventilation, and fire hazard prevention. This updated plan will be reviewed annually to prevent recurrence.
o Implement a quarterly audit system to inspect chemical storage areas, ensuring continued compliance with the updated policies.
- Additional Preventive Systems:
o Review and update fire drills and staff response protocols for handling chemical-related fire hazards.
Step 4: Monitoring and Ensuring Sustained Performance
- Action:
o Conduct quarterly audits at each location to ensure compliance with fire prevention policies, including proper chemical storage practices.
o Management will review audit results during quarterly safety meetings, ensuring any deficiencies are promptly corrected.
o Track incidents of non-compliance and include them in regular staff performance evaluations.
- Responsible Staff:
o The facility director will ensure audits are completed and any issues are addressed.
Step 5: Completion Dates for Corrective Actions
- Immediate Relocation of Hazardous Materials
- Staff Training and Emergency Plan Update: Within 4 weeks.
- Quarterly Audits and Monitoring System Implementation: First audit scheduled for 1/1/25.
Initial Comments:
Based on the findings of an onsite unannounced Medicare recertification survey completed 10/10/2024, Vantage Physical Therapy & Rehabilitation was found to have the following standard level deficiencies that were determined to be in substantial compliance with the following requirements of 42 CFR, Part 485, Subpart H, Conditions of Participation for Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services. The survey was conducted at 311 Warren St Johnstown, PA the parent location on 9/26/2024, and two (2) branch locations located at 409 Bridge St Seward, PA and 1761 Goucher St Johnstown, PA.
Plan of Correction:
485.711(c) STANDARD
EMERGENCY CARE
Name - Component - 00
The rehabilitation agency must establish procedures to be followed by personnel in an emergency, which cover immediate care of the patient, persons to be notified, and reports to be prepared.
Observations:
Based on a review of agency policies/procedures, direct observation (OBV), and staff (EMP) interview, the agency failed to establish emergency procedures for three (3) of three (3) aquatic therapy pools observed (OBV1, OBV2 and OBV3).
Findings included:
Review of the agency policy and procedures was reviewed on 9/27/2024 at approximately 10:05 AM which revealed, "OPERATIONS MANUAL SUBJECT: AQUATIC THERAPY..." No information pertained to aquatic emergencies or removing a patient from aquatic pool environments. The"STAFF EMERGENCY DRILL" were also reviewed and no drills related to the aquatic pool environment were available.
Surveyors conducted an onsite visit (OBV1) at the agency's extension site located at 409 Bridge St Seward PA on 9/26/2024 starting at approximately 9:28 AM. Direct observation of agency's patient treatment revealed an aquatic therapy pool. Subsequent observation of the treatment area revealed a patient in the pool while surveyor was on site. The pool had steps with no ramp, no lift chair or backboard was observed in the aquatic area.
Surveyors conducted an onsite visit (OBV2) at the agency's extension site located at 1761 Goucher St Johnstown PA on 9/26/2024 starting at approximately 10:50 AM. Direct observation of agency's patient treatment revealed an aquatic therapy pool. The pool had steps with no ramp, no lift chair or backboard was observed in the aquatic area. The surveyor ask EMP5 the emergency procedure for removing a patient from the pool area. EMP5 would have to check the policy to confirm. EMP5 confirmed no backboard, lift chair or AED was available at the facility. The surveyor did not observe a lift chair or backboard in the aquatic pool area.
Surveyors conducted an onsite visit (OBV3) at the agency's main located at 311 Warren St Johnstown PA on 9/26/2024 starting at approximately 12:40 PM. Direct observation of agency's patient treatment revealed an aquatic therapy pool. The pool had steps with no ramp, a lift chair was in the closet, no backboard was observed in the aquatic area.
During an interview with EMP4 on 9/27/2024 at approximately 11:30 AM confirmed, No policy and procedures for aquatic emergencies was available to review. No training drill information was provided for emergency extract of patients from aquatic pool area.
An exit interview with the director of operations was conducted on 9/30/2024 at approximately 10:45 PM which confirmed the above findings.
Plan of Correction:Plan of Correction for Deficiency: 485.711(c) – Emergency Care Procedures for Aquatic Therapy Pools
Step 1: Correcting the Deficiency as It Relates to the Individual Sites (OBV1, OBV2, OBV3)
- Action:
o Establish and implement a written emergency procedure specific to aquatic therapy environments, including patient extraction, emergency care, and reporting protocols. This procedure will cover:
Immediate steps to remove a patient from the pool in case of an emergency.
The use of available equipment, such as backboards.
Clear staff responsibilities for contacting emergency services and notifying supervisors.
o Equip all aquatic therapy pool areas with the necessary emergency equipment, including backboards.
- Responsible Staff:
o The director of operations and the site managers are responsible for drafting and implementing the procedures, as well as ensuring the proper emergency equipment is available and in working condition.
- Completion Date: Emergency procedures and equipment installation will be completed within 6 weeks.
Step 2: Protecting Other Patients and Locations in Similar Situations
- Action:
o Update the agency-wide policy manual to include emergency protocols specific to aquatic therapy across all locations.
o Ensure that all locations offering aquatic therapy services, even if not directly observed during the survey, have the same emergency equipment installed and readily available.
o Conduct staff training across all sites on the updated emergency procedures, including patient extraction from the pool, use of emergency equipment, and communication protocols during an emergency.
o Implement aquatic therapy-specific emergency drills that will be conducted during regular Table-Top emergency drills, with results documented.
- Staff Training:
o All staff members involved in aquatic therapy will undergo training on the updated emergency procedures, focusing on patient extraction techniques, equipment use, and the chain of command in emergencies.
o In-service training will be repeated annually.
Step 3: Systems and Measures to Prevent Recurrence
- Action:
o The emergency procedures for aquatic therapy will be incorporated into the general emergency preparedness plan and reviewed on an annual basis.
o A regular audit system will be established to ensure that all aquatic therapy pools are equipped with functioning emergency equipment (backboards) and that staff are familiar with emergency procedures.
o Clear signage will be installed in all aquatic therapy areas detailing the location of emergency equipment and outlining basic emergency procedures for staff and patients.
Step 4: Monitoring and Ensuring Sustained Performance
- Action:
o The facility will conduct quarterly audits of all aquatic therapy locations to ensure the proper implementation of emergency procedures and the availability of necessary equipment.
o Annual training and competency assessments on emergency procedures, including patient extraction from pools, will be conducted for all staff.
o Drill results and performance will be tracked and reviewed in management meetings, with corrective actions taken as necessary.
- Responsible Staff:
o The director of operations will oversee compliance with audits and monitor staff performance in relation to emergency preparedness for aquatic therapy.
o Site managers at each location will ensure drills are conducted and equipment is maintained.
Step 5: Completion Dates for Corrective Actions
- Establishment of Emergency Procedures: Within 6 weeks.
- Staff Training on New Procedures: Within 6 weeks.
- Installation and Inspection of Emergency Equipment: Within 6 weeks
- Quarterly Audits and Emergency Drills: 1/1/2025
485.713(b) STANDARD
FACILITIES AND EQUIPMENT
Name - Component - 00
The organization has the equipment and facilities required to provide the range of services necessary in the treatment of the types of disabilities it accepts for service.
Observations:
Based on review of agency policy, aquatic logs and staff (EMP) interview, the facility failed to ensure that the therapeutic pools were maintained according to agency parameters for two (2) of three (3) agency sites observed (OBV1 and OBV2).
Review of the agency policy was conducted on 10/10/2024 at approximately 3:40 PM revealed, "Aquatic Pools, Cultures are performed quarterly on all aquatic pools. * Pool is checked every day patients are in the pool (Monday-Friday) with the appropriate test strips. It is documented the results and chemicals are added as needed to balance the pool based on their findings. *Pool temperature should be kept at 92 +/- degrees F and checked on a regular basis. *Visual inspections are to be performed daily when opening and closing the pool. *Pools are shocked once a week with a 15-minute shock, unless additional need is indicated by the pool strip. *Vacuuming, filter cleaning, pool draining and cleaning, and cleaning the edges around the pool are done on an as-needed bases, based on visual inspection and pool strip indications. *Water is added to the pools as needed.
Saltwater Aquatic Pool-Westmont ONLY *Cultures are performed quarterly on the saltwater aquatic pool. *Saltwater pool is checked every day patients are in the pool (Monday-Friday) with the appropriate test strips. It is documented the results and chemicals are added as needed to balance the pool based on their findings. *Pool temperature is kept at 92 +/- degrees F and checked daily. *Visual inspections are performed numerous times a day, especially when opening and closing the pool. *The pump monitors if salt is needed to be added to the pool. Salt will beaded as needed to balance pool based on pump light if salt is required. *Pool is shocked twice a week to keep chorine levels in check with the saltwater. This is done at the end of day. *Vacuuming, filter cleaning, and pool draining are done on an as needed basis. This is based on visual inspection and pool strip indications. *Water is added to the pool at least once week in contingence with chemical balance. *Pool lining and pool edge are wiped down monthly and as needed to keep the pool cleaner..."
A request on 9/26/2024 at approximately 2:05 PM was made from EMP4 for the Pool logs for three visit sites for a two-month period starting from 8/1/2024 to 9/26/2024.
Surveyors conducted an onsite visit (OBV1) at the agency's extension site located at 409 Bridge St Seward PA on 9/26/2024 starting at approximately 9:28 AM. Direct observation of agency's patient treatment area revealed an aquatic therapy pool.
Logs revealed daily recorded pool temperature were not monitored for the following dates: from 8/1/2024 to 9/26/2024.
Logs revealed daily recorded "pH (7.2-7.8)" levels not within agency parameters for the following dates:
8/1/2024 to 8/12/2024 and 9/2/2024 to 9/25/2024.
Logs revealed daily recorded "Total Alkalinity (80-120 ppm)" not within agency parameters for the following dates:
8/1/2024 to 8/15/2024 and 8/28/2024 to 9/25/2024.
Surveyors conducted an onsite visit (OBV2) at the agency's extension site located at 1761 Goucher St Johnstown PA on 9/26/2024 starting at approximately 10:50 AM. Direct observation of agency's patient treatment area revealed an aquatic therapy pool.
Logs revealed daily recorded "Total Chlorine (1-5)" levels not within agency parameters for the following dates: 8/1/2024, 8/6/2024, 8/7/2024, 8/14/2024, 8/16/2024, 8/19/2024, 8/21/2024, 8/28/2024, 9/17/2024 and 9/20/2024.
Logs revealed daily recorded "PH (7.2-7.6)" levels not within agency parameters for the following dates:
8/6/2024
8/7/2024
8/9/2024 to 8/15/2024
8/20/2024 to 9/4/2024
9/10/2024
9/17/2024 to 9/25/2024
An exit interview with the director of operations was conducted on 9/30/2024 at approximately 10:45 PM which confirmed the above findings.
Plan of Correction:Plan of Correction for Deficiency: 485.713(b) – Facilities and Equipment (Aquatic Therapy Pool Maintenance)
Step 1: Correcting the Deficiency as It Relates to the Individual Sites (OBV1 and OBV2)
- Action:
o Immediately update the monitoring process for pool parameters, including temperature, pH levels, total alkalinity, and chlorine levels, to ensure they are within the required ranges.
o Recalibrate or replace any malfunctioning equipment used to measure pool parameters to ensure accurate readings.
o Log all daily pool maintenance activities, including temperature, pH, total alkalinity, and chlorine level readings, and record any corrective actions taken.
- Responsible Staff:
o The site managers will be responsible for implementing immediate corrective actions and ensuring proper daily logging of pool parameters.
- Completion Date: Corrective actions and updated pool monitoring to be completed by 2 weeks.
Step 2: Protecting Other Patients and Locations in Similar Situations
- Action:
o Implement a standardized agency-wide protocol for monitoring pool maintenance to ensure compliance with pH, chlorine, total alkalinity, and temperature requirements at all locations.
o Conduct a review of pool logs at all locations offering aquatic therapy to identify any additional deficiencies and correct them as necessary.
o Update training for staff responsible for pool maintenance on how to accurately measure and record pool parameters and the actions required if parameters are outside the acceptable range.
o Post a clear checklist in all aquatic therapy areas for staff to follow during daily pool inspections, ensuring consistency across locations.
- Staff Training:
o All staff responsible for pool maintenance will receive refresher training on the importance of daily parameter checks, how to correctly document readings, and how to adjust chemical levels when necessary.
o Staff training will include a focus on understanding the impact of chemical imbalances and temperature fluctuations on patient safety and therapy effectiveness.
Step 3: Systems and Measures to Prevent Recurrence
- Action:
o Set up a quarterly pool maintenance audit across all locations to verify adherence to agency policies.
Step 4: Monitoring and Ensuring Sustained Performance
- Action:
o Conduct quarterly internal audits of pool maintenance logs at each site to ensure daily parameter checks are performed and properly documented.
o Site managers will review audit results with their teams monthly to address any recurring issues and make necessary adjustments to pool maintenance protocols.
- Responsible Staff:
o The director of operations will oversee the quarterly audits and ensure consistent compliance across all locations.
- Monitoring Start Date: Ongoing audits to begin 1/1/2025.
Step 5: Completion Dates for Corrective Actions
- Correction of Pool Parameters and Daily Logging: Within 2 weeks
- Staff Training on Pool Maintenance and Logging: Within 2 weeks
- Implementation of Audit Procedures: Beginning next quarter, 1/1/2025
485.723(b) STANDARD
MAINTENANCE OF EQUIPMENT/BUILDINGS/GROUNDS
Name - Component - 00
The organization establishes a written preventive maintenance program to ensure that the equipment is operative and is properly calibrated, and the interior and exterior of the building are clean and orderly and maintained free of any defects which are a potential hazard to patients, personnel, and the public.
Observations:
Based on a review of agency policies/procedures, direct observation (OBV), and staff (EMP) interview, the agency failed to have aquatic pool chemicals properly stored for one (1) of three (3) agency sites observed (OBV1).
Findings included:
Review of the facility documentation was conducted on 9/27/2024 at approximately 11:30 AM which revealed, "Emergency Preparedness ...Fire Prevention ...The first step in our fire plan is for staff to take steps to prevent a fire. The following actions will be undertaken...6. To prevent storage containers, including trash from becoming a fire hazard following procedures will be followed...b. Combustible items are stored away from heat producing appliances..."
A review of the safety data sheet on 9/27/2024 at approximately 10:20 PM revealed, "Product Identifier Zappit 73...Company Name Westlake Corporation...Storge Store in a well-ventilated place, Keep container tightly closed, Store locked up...7. Handling and storage Precaution for safe handling ...Observe good industrial hygiene practices. Do not mix this product with any other chemicals, including any other pool chemicals of any kind, such as other disinfection or "shock" pool products. Contamination with moisture, acids, organic matter other chemicals (including , but not limited to cleaning chemicals and other pool chemicals), petroleum or paint products or other easily combustible materials may start a chemical reaction with generation of heat, liberation of hazardous gases and possible violent reaction leading to fire or explosion. Always add product to large quantities of water to fully dissolve product. Do not pour water into product, always add product to water. Do not use with stabilized chlorine or bromine tablet chemical feeders. Do not add this product to any dispensing device containing remnants of any other product or pool chemical. Conditions for safe storage, including any incompatibilities, Sore locked up. Keep away from heat. Store in a cool, dry place out of direct sunlight. Store in tightly closed container. Store in a well-ventilated place. Do not store near combustible materials. Store away from incompatible materials..."
Surveyors conducted an onsite visit (OBV1) at the agency's extension site located at 409 Bridge St Seward PA on 9/26/2024 starting at approximately 9:28 AM. Direct observation of agency's patient treatment revealed an aquatic therapy pool. Next to the pool were three containers stacked on top of each other. The top container was listed "POOL Brite pH PLUS" the middle container was labeled "ZAPPIT 73" and the bottom container was labeled "POOL Brite CALCIUM BOOSTER ..."
During an interview with EMP4 on 9/26/2024 at approximately 1:18 PM the surveyor made EMP4 aware of the EPA warning label of one of the pool products. The surveyor showed EMP4 of a picture of the materials and their location. EMP4 stated that EMP6 would be contacted and made aware of the situation immediately.
An exit interview with the director of operations was conducted on 9/30/2024 at approximately 10:45 PM which confirmed the above findings.
Plan of Correction:Plan of Correction for Deficiency: 485.723(b) – Maintenance of Equipment/Buildings/Grounds (Improper Storage of Aquatic Pool Chemicals)
Step 1: Correcting the Deficiency as It Relates to the Individual Site (OBV1)
- Action:
o Immediately relocate the improperly stored chemicals (POOL Brite pH PLUS, ZAPPIT 73, and POOL Brite CALCIUM BOOSTER) to a well-ventilated, cool, dry storage area, away from heat sources and other incompatible materials, as specified by the safety data sheet.
o Separate the storage of chemicals to ensure that incompatible substances are not stacked or stored near each other, preventing any risk of reaction.
o Verify that storage containers are sealed tightly and stored in compliance with fire safety regulations and SDS guidelines.
- Responsible Staff:
o The site manager will oversee the immediate relocation of chemicals and ensure that storage practices comply with safety regulations.
- Completion Date: Completed Immediately.
Step 2: Protecting Other Patients and Locations in Similar Situations
- Action:
o Review and update the facility-wide preventive maintenance program to include specific guidelines for the proper storage and handling of chemicals, with emphasis on aquatic pool chemicals.
o Conduct an inspection of all locations with aquatic therapy pools to ensure that chemicals are stored in accordance with SDS guidelines and fire safety regulations.
o Implement a staff education program across all sites to train personnel on safe chemical handling, storage, and emergency procedures in case of accidental spills or reactions.
o Ensure that all chemical storage areas are labeled with clear signage indicating storage precautions and incompatibilities.
- Staff Training:
o All personnel responsible for handling and storing chemicals will undergo training on safe chemical storage practices, including compliance with SDS guidelines and fire prevention.
o Annual refresher training will be scheduled for all staff who manage chemicals to reinforce safe storage practices and update them on any changes to safety procedures.
Step 3: Systems and Measures to Prevent Recurrence
- Action:
o Implement a quarterly audit of all storage areas across all locations, focusing on the proper storage of chemicals, ensuring adherence to safety data sheets and fire safety guidelines.
o Revise the emergency preparedness and fire prevention plans to specifically include actions and precautions regarding chemical storage and handling.
Step 4: Monitoring and Ensuring Sustained Performance
- Action:
o Conduct quarterly inspections at each site to ensure compliance with chemical storage regulations, including the proper separation of incompatible chemicals and adequate ventilation in storage areas.
o The director of operations will receive quarterly audit reports from site managers, summarizing the state of compliance with chemical storage standards and corrective actions taken.
o Staff performance in maintaining chemical safety will be evaluated annually, and corrective actions will be taken as needed.
- Responsible Staff:
o The site managers and Director of Operations will be responsible for ongoing compliance and monitoring.
o The director of operations will review all audit reports and ensure that deficiencies are corrected promptly.
- Monitoring Start Date: Quarterly inspections and monitoring systems to begin next quarter, 1/1/2025.
Step 5: Completion Dates for Corrective Actions
- Relocation of Hazardous Materials: Immediately
- Staff Training and Preventive Maintenance Program Updates: Within 4 weeks
- Quarterly Audits and Monitoring System Implementation: First audit scheduled for beginning of next quarter, 1/1/2025.
|