Affinity Nursing & Rehab Center

F-F600

Review of the facility's policy dated 02/2025 and titled, Abuse, Neglect, and Exploitation revealed in part, the following:

Definitions:

Physical Abuse-includes, but is not limited to hitting, slapping, punching.

Reporting/Response:

1. Reporting of all alleged violations to the Administrator, state agency .within specified timeframes:

a. Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse.

Resident #1

Review of Resident #1's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Schizophrenia.

Resident #2

Review of Resident #2's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Cervical Disc Disorder.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Resident #3

Level of Harm - Actual harm Review of Resident #3's Clinical Record revealed she was admitted to the facility on [DATE REDACTED] with diagnoses, which included Cognitive Communication Deficit. Residents Affected - Some Resident #4

Review of Resident #4's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Traumatic Brain Injury and Dementia.

1.

Review of the facility's incident report dated 01/18/2025, revealed in part, the following:

Incident Description: S7CNA reported Resident #1 and Resident #2, were arguing in their room, and Resident #2 hit Resident #1 with a reacher tool at 6:30 p.m.

An interview was conducted on 02/10/2025 at 10:30 a.m., with Resident #1. He stated a few weeks ago, he punched Resident #2 on his face a few times with his right hand. He stated Resident #2 poked him with his reacher tool so he punched him. He stated he did not have any pain or swelling to the right hand after punching Resident #2 until two days later when he was diagnosed with a right finger fracture.

An interview was conducted on 02/10/2025 at 2:15 p.m., with S7CNA. She stated she witnessed the altercation between Resident #1 and Resident #2 on 01/18/2025. She stated she heard raised voices coming from Resident #1 and Resident #2's room. She stated when she entered the room, Resident #2 was standing at Resident #1's bedside poking him with his reacher tool. She stated Resident #1 then punched Resident #2 three times on the side of his face with a closed fist. She stated she notified S4LPN of the altercation immediately on 01/18/2025 around 6:30 p.m. She stated a resident punching another resident was a type of physical abuse and should be reported.

An interview was conducted on 02/10/2025 at 2:20 p.m., with S4LPN. She stated S7CNA notified her immediately of the incident on 01/18/2025 around 6:30 p.m. She stated she did not report the incident to anyone else until 01/20/2025, when Resident #1 was noted to have swelling of his right hand. She stated Resident #1 had a mobile x-ray on 01/20/2025 completed which resulted as a 5th Metacarpal Neck Fracture of the Right Hand. She stated a resident punching another resident was physical abuse and should be reported. She stated she knew to report it, but she failed to do so on 01/18/2025.

An interview was conducted on 02/11/2025 at 2:02 p.m., with S9NP. She stated she was the on-call nurse practitioner for 01/18/2025. She reviewed her call logs for 01/18/2025 and confirmed she did not receive a notification of the altercation between Resident #1 and Resident #2 and should have.

An interview was conducted on 02/10/2025 at 1:45 p.m., with S1ADM. He stated S4LPN should have reported the physical abuse between Resident #1 and Resident #2 to him on 01/18/2025 and did not until 01/20/2025. He stated all physical abuse should be reported to the DON and Administrator immediately and reported to the state agency within 2 hours.

2.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 11 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Review of the facility's incident report dated 12/24/2024, revealed in part, the following:

Level of Harm - Actual harm Incident Description: S3LPN was notified by S6CNA at 11:45 a.m. that Resident #2 had slapped Resident #3

in the face. Residents Affected - Some

An interview was conducted on 02/10/2025 at 1:45 p.m., with S6CNA. She stated she witnessed the incident which occurred on 12/24/2024 at 11:45 a.m. between Resident #2 and Resident #3. She stated on 12/24/2024, Resident #2 slapped Resident #3. She stated she separated both residents and immediately reported the incident to S3LPN on 12/24/2024 at 11:45 a.m. She stated a resident slapping another resident was a type of physical abuse and should be reported.

An interview was conducted on 02/10/2025 at 1:55 p.m., with S3LPN. He stated on 12/24/2024, S6CNA notified him around 11:45 a.m. of Resident #2 slapping Resident #3 on the forehead. He stated he immediately reported the incident to S8NP and S1ADM on 12/24/2024. He stated a resident slapping another resident was a type of physical abuse and should be reported.

Review of the facility's incident report dated 12/18/2024, revealed in part, the following:

Incident Description: Resident #1 went to the nurses' station and stated, I f***ed him up. He stated he was referring to Resident #4. Staff immediately went into the residents' room and found Resident #4 with scratches to his left arm. Resident #1 had a deep laceration between his thumb and pointer finger on his right hand. Resident #1 stated, Everyday he is just sleeping and I'm tired of it.

An interview was conducted on 02/10/2025 at 10:10 a.m., with S5LPN. She stated on 12/18/2024, around midnight, Resident #1 and Resident #4 got into an altercation. She stated she immediately separated them, and placed Resident #1 in another room. She stated 1:1 monitoring began on both residents. She stated Resident #1 was sent to a behavioral hospital on the morning of 12/19/2024. She stated she notified the NP, DON, and RP of the incident on 12/19/2024 around 7:00 a.m. She stated a resident scratching another resident was a type of physical abuse and should be reported.

An interview was conducted on 02/10/2025 at 1:45 p.m., with S1ADM. He stated in December 2024 through January 2025, S2CON was responsible for reporting to the state agency and he was the DON. He stated he became the Administrator later in January 2025 after the aforementioned incidents. He stated he was aware of the incidents which occurred on 12/18/2024, 12/24/2024, and 01/18/2025. He confirmed the incidents were abuse, should have been reported, and were not.

An interview was conducted on 02/11/2025 at 2:00 p.m., with S2CON. She stated in December 2024 through January 2025, she was responsible for reporting to the state agency and was the Administrator during that time. She stated she was aware of the incidents which occurred on 12/18/2024, 12/24/2024, and 01/18/2025.

She stated these incidents were not physical abuse, and therefore she did not report them to the state agency.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0644 Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 46981

Residents Affected - Some Based on record review and interviews, the facility failed to ensure residents with an identified mental health diagnosis were referred for a Preadmission Screening and Resident Review (PASARR) Level II evaluation as required for 2 (#1 and #2) of 4 (#1, #2, #3, and #4) residents reviewed for PASARR.

Findings:

Review of the facility's policy dated 02/2025 and titled, Resident Assessment-Coordination with PASARR Program revealed in part, the following:

1. All applicants to this facility will be screened for serious mental disorders or intellectual disabilities and related conditions in accordance with State's Medicaid rules for screening.

1ai. Negative Level I Screen-permits admission to proceed and ends the PASARR process unless a possible serious mental disorder or intellectual disability arises later.

Resident #1

A review of Resident #1's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Schizophreniform Disorder. Further review revealed additional medical diagnosis of Unspecified Psychosis (onset date of 12/19/2024).

Further review revealed Resident #1 was diagnosed with Unspecified Psychosis on 12/19/2024 and no

review for a Level II evaluation and determination had been submitted after Resident #1 received this diagnosis.

Resident #2

A review of Resident #2's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Cervical Disc Disorder with Myelopathy. Further review revealed additional medical diagnosis of Bipolar Disorder (onset date of 01/02/2025).

Further review revealed Resident #2 was diagnosed with Bipolar Disorder on 01/02/2025 and no review for a Level II evaluation and determination had been submitted after Resident #2 received this diagnosis.

An interview was conducted on 02/11/2025 at 11:10 a.m., with S11SW. She stated she was responsible for filing PASARR Level I and II paperwork in resident records. She stated she was unsure who was responsible for completing resident assessment following a new psychiatric diagnosis, and who was responsible for submitting a new Level I Pre-admission Screening and Resident Review to determine candidacy for Level II services.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0644 An interview was conducted on 02/11/2025 at 11:15 a.m., with S1ADM. He stated he was unsure of who was responsible for completing resident assessment following a new psychiatric diagnosis, and who was Level of Harm - Minimal harm or responsible for submitting a new Level I Pre-admission Screening and Resident Review to determine potential for actual harm candidacy for Level II services. He stated S10PNP may have more information regarding roles/responsibilities pertaining to psychiatric services and PASARR. He reviewed both Resident #1 and Residents Affected - Some Resident #2's diagnoses and confirmed that they acquired new psychiatric diagnoses since Level I approval, and a new Level I Pre-admission Screening and Resident Review was not completed and should have been.

An interview was conducted on 02/11/2025 at 11:38 a.m., with S10PNP. She stated she was responsible for assessing and treating residents with psychiatric diagnoses on a routine basis. She stated any evaluations, new diagnoses, treatment notes, and recommendations were reported via email to the Administrative staff.

She further stated she was not responsible for submitting a new Level I Pre-admission Screening and Resident Review to determine candidacy for Level II services.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently.

Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 46981

Residents Affected - Some Based on interviews and record review, the facility failed to be administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being for each resident residing in the facility. The facility failed to have an effective system

in place to ensure:

1. Residents with newly diagnosed mental illnesses were reevaluated for PASRR Level II determinations for 2 (#1 and #2) of 4 (#1, #2, #3, and #4) residents reviewed for PASRR; and

2. Allegations of physical abuse were reported to the state agency, immediately but not later than 2 hours

after the allegation for 4 (#1, #2, #3, and #4) of 4 (#1, #2, #3, and #4) residents reviewed for abuse; and

3. Allegations of physical abuse were reported to the administrator immediately after the allegation for 2 (#1 and #2) of 4 (#1, #2, #3, and #4) residents reviewed for abuse.

The deficient practice had the potential to affect a census of 110 residents. This deficient practice resulted in

an actual physical harm on 01/18/2025, when Resident #1, a cognitively intact Resident, punched Resident #2 in his face three times. Resident #1 was diagnosed with Unspecified Fracture of Fifth Metacarpal Bone of his Right Hand on 01/20/2025.

Findings:

Cross Reference

F-F644.

1.

Resident #1

A review of Resident #1's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Schizophreniform Disorder.

Further review revealed Resident #1 was diagnosed with Unspecified Psychosis on 12/19/2024 and no documentation a Level II evaluation and determination had been submitted after Resident #1 received this diagnosis.

Resident #2

A review of Resident #2's Clinical Record revealed he was admitted to the facility on [DATE REDACTED].

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 Further review revealed Resident #2 was diagnosed with Bipolar Disorder on 01/02/2025 and no documentation a Level II evaluation and determination had been submitted after Resident #2 received this Level of Harm - Actual harm diagnosis.

Residents Affected - Some An interview was conducted on 02/11/2025 at 11:10 a.m. with S11SW. She stated she was responsible for filing PASRR Level I and II paperwork in resident records upon admission to the facility. She stated she was unsure who was responsible for completing resident assessments following a new psychiatric diagnosis after admission, and who was responsible for submitting a new Resident Review to determine candidacy for Level II services.

An interview was conducted on 02/11/2025 at 11:15 a.m. with S1ADM. He stated he was unsure who was responsible for completing resident assessments following a new psychiatric diagnosis, and who was responsible for submitting a new Level I Pre-admission Screening and Resident Review to determine candidacy for Level II services. He reviewed both Resident #1 and Resident #2's diagnoses and confirmed

they acquired new psychiatric diagnoses since Level I approval, and a new Level I Pre-admission Screening and Resident Review was not completed and should have been.

An interview was conducted on 02/11/2025 at 2:00 p.m. with S2CON. She stated she was unaware of who was responsible for ensuring residents received evaluations for PASRR determination of services after new psychiatric diagnoses.

2.

Resident #1

Review of Resident #1's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Schizophrenia.

Review of Resident #1's MDS with an ARD of 11/06/2024 revealed a BIMS of 13, which indicated he was cognitively intact.

Resident #4

Review of Resident #4's Clinical Record revealed he was admitted to the facility on [DATE REDACTED] with diagnoses, which included Traumatic Brain Injury and Dementia.

Review of Resident #4's MDS with an ARD of 10/09/2024 revealed a BIMS of 13, which indicated he was cognitively intact.

Review of the facility's incident report dated 12/18/2024, revealed in part, the following:

Incident Description: Resident #1 went to the nurses' station and stated, I f***ed him up. He stated he was referring to Resident #4. Staff immediately went into the residents' room and found Resident #4 with scratches to his left arm. Resident #1 had a deep laceration between his thumb and pointer finger on his right hand. Resident #1 stated, Everyday he is just sleeping and I'm tired of it.

Resident #3

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 Review of Resident #3's Clinical Record revealed she was admitted to the facility on [DATE REDACTED] with diagnoses, which included Cognitive Communication Deficit. Level of Harm - Actual harm

Review of Resident #3's MDS with an ARD of 11/13/2024 revealed a BIMS of 13, which indicated she was Residents Affected - Some cognitively intact.

Review of the facility's Incident Log dated December 2024 through January 2025 revealed the following:

A physical aggression incident between Resident #2 and Resident #3 on 12/24/2024.

Review of the facility's incident report dated 12/24/2024, revealed in part, the following:

Incident Description: S3LPN was notified by S6CNA at 11:45 a.m. that Resident #2 had slapped Resident #3

in the face.

An interview was conducted on 02/10/2025 at 1:45 p.m. with S1ADM. He stated December 2024 through January 2025, S2CON was responsible for reporting to the state agency and he was the DON. He stated he was aware of the incidents which occurred on 12/18/2024, 12/24/2024, and 01/18/2025. He confirmed the incidents were abuse, should have been reported to state agency, and were not.

An interview was conducted on 02/11/2025 at 2:00 p.m. with S2CON. She stated December 2024 through January 2025, she was responsible for reporting to the state agency and was the Administrator during that time. She stated she was aware of the incidents which occurred on 12/18/2024, 12/24/2024, and 01/18/2025.

She stated these incidents were not physical abuse, and therefore she did not report them to the state agency.

3.

Review of the facility's incident report dated 01/18/2025, revealed in part, the following:

Incident Description: S7CNA reported Resident #1 and Resident #2 were arguing in their room, and Resident #2 hit Resident #1 with a reacher tool at 6:30 p.m.

An interview was conducted on 02/10/2025 at 2:15 p.m. with S7CNA. She stated she witnessed Resident #1 punch Resident #2 on 01/18/2025. She stated she notified S4LPN of the altercation immediately on 01/18/2025 around 6:30 p.m.

An interview was conducted on 02/10/2025 at 2:20 p.m. with S4LPN. She stated S7CNA notified her immediately of the incident on 01/18/2025 around 6:30 p.m. She stated she did not report the incident to anyone else until 01/20/2025, when Resident #1 was noted to have swelling of his right hand. She stated Resident #1 had a mobile x-ray on 01/20/2025 completed which resulted as a 5th Metacarpal Neck Fracture of the Right Hand. She stated a resident punching another resident was physical abuse and should be reported. She stated she knew to report it, but she failed to do so on 01/18/2025.

An interview was conducted on 02/10/2025 at 1:45 p.m. with S1ADM. He stated he was made aware on 01/20/2025 of the incident between Resident #1 and Resident #2 which occurred on 01/18/2025. He confirmed the incident was abuse, should have been reported on 01/18/2025, and was not.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 18 195505 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 195505 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mid City Community Nursing and Rehab 4005 North Blvd Baton Rouge, LA 70806

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 An interview was conducted on 02/11/2025 at 2:00 p.m. with S2CON. She stated she was made aware on 01/20/2025 of the incident between Resident #1 and Resident #2 which occurred on 01/18/2025. She stated Level of Harm - Actual harm this incident was not physical abuse.

Residents Affected - Some

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 18 of 18 195505