Inspection on 14/10/09 for Samuel Hobson House

This is the latest available inspection report for this service, carried out on 14th October 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Samuel Hobson House 20 Knutton Road Wolstanton Staffordshire ST5 0HU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joy Hoelzel     Date: 1 4 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Samuel Hobson House 20 Knutton Road Wolstanton Staffordshire ST5 0HU 01782620011 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): annel@acacia-training.org Littleton Holdings Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 39 The minimum age on admission shall be from 55 years The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Code DE (39). Date of last inspection Brief description of the care home Samuel Hobson House is a purpose built, social care home providing accommodation and personal care for up to thirty nine people. It provides long and short term care for people with dementia. It is privately owned by Littleton Holdings Ltd. It is situated in a residential area but within easy reach of nearby shops and the local community amenities. Care Homes for Older People Page 4 of 27 Over 65 39 0 Brief description of the care home Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents are readily available on request at the home. The service user guide includes details of the current level of weekly fees, ranging from £400.00 - £600.00 depending on the agreed package of care. Further details can be obtained directly from the home. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is our first inspection of the home since the service was registered in May 2009. The home did not know that we would be visiting to conduct a full inspection. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that Care Homes for Older People Page 6 of 27 is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The acting home manager completed this document and returned it to us at the beginning of October 2009. Comments from the AQAA are included within this inspection report. We asked for our surveys to be distributed at the home prior to the inspection. We had three returned that had been completed by relatives on behalf of their family member living at the home. One staff member completed the survey and returned it to us. The comments are included in this report. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home, until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information on the home is provided in two documents. The statement of purpose, which sets out what the service offers and the residents guide which offers more information when a person decides to move in. Both documents are available directly from the home. The home supplied us with the documents when we asked for them. The weekly fees are detailed in the service user guide and range from £400.00 £600.00 depending on the agreed package of care. The Aqaa completed by the acting care manager described the action they take to ensure the home can be fully prepared and able to meet a person care needs. Prior to or on admission a resident profile would be completed by the resident/relative to give us full details of the persons background and history (this is very important and Care Homes for Older People Page 10 of 27 Evidence: informative for the staff team for someone who is suffering from Dementia or Alzheimers). This information then also becomes part of the Care Plan and they will all be details that make the plan person centred. We looked at the case file of the person who recently moved into the home. The contents in the file confirmed that information had been sought regarding this persons needs prior to them moving in. Information had been gathered from the previous health care setting and a pre admission assessment was completed by the service. Other case files looked at included a pre admission assessment by the home in addition to social worker reviews and assessments from other health and social care settings. This gathering of information ensures that the service can be confident of meeting a persons care needs. One person told us that they and their family came to have a look at the home prior to the decision being made to move in. They went on to say that of course they would prefer to be at home but said I and very comfortable and satisfied with life here. A relative completed our survey and indicated that they had received enough information to help to make the decision for their family member to move into the home We couldnt have chosen a better place we are totally satisfied. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that they will receive support and care in the way they prefer and need. Evidence: All people living at the home have their care needs assessed prior to them moving into the home. An individualised person centred plan is then drawn up from this information and is updated at regular intervals or when a change has been identified. We selected four case files to look at in depth, with other files looked at briefly to follow up any observations made during the inspection. We saw that the plans had been completed with the person (whenever possible) and/or their representative or advocate. Each plan documented the details of the care required, how the care was to be provided and the expected result of the care. The plans offered an overall picture of the care needs of the person. For example a person occasionally experiences periods of distress and anguish due to a specific condition. The plan recorded the possible triggers to this and the action staff could take to help relieve the stress to this person. Another plan gave staff the Care Homes for Older People Page 12 of 27 Evidence: information for helping a person to remain safe in the home. All the plans that we looked at contained a care plan for helping a person with their personal hygiene and all people looked very well groomed. Staff were very quick to attend when a persons personal hygiene became compromised. However, we found that there were some omissions of information when we were observing practice and talking to people. For example one person is experiencing some difficulty with eating and drinking, the case file did not include a specific risk assessment for maintaining adequate nutrition. Another person is at risk of developing pressure areas due to a frail condition, the care plan documents that creams should be applied. An intervention document had been completed but did not specify which cream had been applied and to which area. We discussed these omissions with the senior staff who offered an assurance that action would be taken to review and amend the care plans. Some people living at the home told us that they were well cared for and that the staff looked after them very well. For some people it was not possible to engage them fully in conversation, but they appeared well cared for and quite happy in their surroundings. We spoke with staff and they described the diverse care needs of the people and the way they helped and assisted people each day. We looked at the systems for administering medication to people and found that the areas for storing medication were safe and secure. Staff explained the procedures and we looked at the medication administration records (MAR) for a selection of people. We observed staff completing the MAR at the time of giving out the medication, it appeared that the charts were being fully completed we did not see any gaps in the recording. Some people at the home have been prescribed medications that are to be taken on an as required basis. Staff told us that there are no written protocols or instructions for what triggers the medications to be given or for how often it can be given. We advised that protocols for all as required medications should be available for reference. The Aqaa tells us that Staff are expected and trained on how to care for residents as individuals, with respect and dignity at all times. We saw that staff were very patient, understanding and caring. They assisted people with care needs in a discreet and respectful way; they explained what they were going to do before actually starting the task. Thereby putting the person at ease and alleviating any stress that the person may be feeling. The care records recorded the name that people preferred to be called and through Care Homes for Older People Page 13 of 27 Evidence: out the day we heard staff addressing people accordingly. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be assured that they will be offered and supported with meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. Evidence: The Aqaa tells us that- The aim of the Home is to offer 4 activities a day both within and outdoors. Activities are sourced to be suitable for the residents within our care including reminiscence sessions and incorporating activities they may of had interest in prior to coming to Samuel Hobson House or in their past, that if they were reintroduced to may give them comfort and a feeling of trust and wellbeing. The Home has a full time Activities coordinator, who works hours during the day, in the evening and weekends. We saw that there was lots of activity happening throughout the day, people were engaging and participating in a variety of leisure interests. Some people were sitting quietly reading the daily newspaper, others were watching the television, and some were joining in with the painting group. We saw the activity coordinator arranging activities with people at the time that they chose and wanted to do something. We saw that in addition to group activities there was also opportunity for people to have Care Homes for Older People Page 15 of 27 Evidence: one to one time with staff. One person told us that they enjoyed attending the religious service at the home and that their continued observance is very important to them. Through out the day we saw that many people were visiting the home. People told us that they were satisfied with the visiting arrangements and could call at any time. They told us that the staff are pleasant and welcoming. The main front door is kept locked for security reasons. A CCTV camera is positioned at the front door, for additional security. Inside the home there are number key pads sited on the doors to the units that restrict access to and from some areas. The deputy manager explained that at times during the day, the doors are opened so that people can wander around the home into different areas in safety. Bedrooms are locked during the day; most people would be unable to maintain a key to their door. One person told us that they had not been offered a key to their room but they thought it be a good idea if they could have one then. Staff told us that people can go to their bedrooms when ever they request to do so, but the rooms are kept locked because of the possibility of other people going into the rooms and removing personal possessions. We saw that during the morning two people requested to go to their rooms to have a lie down, staff helped them with this. The meals are all freshly prepared by the catering staff and are served in the dining areas or in other areas if people wish not to use the dining facilities. Most people are encouraged to use the dining facilities as it is viewed as an opportunity for socialising. The dining areas were well prepared in advance of the meal, with the food served appetising and nutritious. People told us that the meals were very good and that they were satisfied with the menu. We observed good practice when staff were assisting with lunch, demonstrating a clear understanding of peoples requirements and needs. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Evidence: The Aqaa tells us that The procedure in relation to complaints is given on admission and is also available in reception. People told us they Would talk to the manager if they had any concerns or their family would sort it out. People visiting told us that they were fully satisfied with the care and service provided and that they were aware of the procedures if they had any cause to complain. A comments book is available in the reception area for people to put any positive or negative comments. The last entry made in the book is A very pleasant environment, nice and clean, staff are very friendly. The senior staff told us of the open door policy of the acting manager so that people are able to discuss any worries, concerns or grumbles with them and anything Would be quickly sorted The Aqaa tells us that that the service has not received any concerns or complaints since it opened. We, the commission, have not received any correspondence in this area. The staff told us that they had received recent training in the protection of vulnerable adults, and explained what the action they would take if they had any suspicions of Care Homes for Older People Page 17 of 27 Evidence: wrong doings. Senior staff told us that they had training in the Mental Capacity Act and Deprivation of Liberty safeguards. They have plans to cascade the information to all levels and grades of staff. There is a facility for the service to safe keep small amounts of a persons money. Separate records are maintained for each person and the money is stored individually in a locked safe. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is satisfactory to the specific needs of the people who live there. Evidence: Samuel Hobson House is a purpose built social care home providing accommodation for up to thirty nine older people. The accommodation is spacious, well decorated, well furnished and comfortable. People we spoke with told us that they are very satisfied with the accommodation provided. They said that their bedrooms are warm, the beds comfortable and that they can personalise their own rooms with family photographs, pictures, ornaments and electrical items such as televisions, as seen during a tour of the home. One person said Of course I would prefer to be at home but I am very comfortable and satisfied. People who were unable to comment appeared well settled and comfortable. During the tour of the building we saw that bed rails had been fitted to one of the beds, after a potential risk of a person falling from the bed had been identified. The rails were very loose and not fitted securely. We spoke with the deputy care manager about this who took immediate action to ensure that the rails were fitted correctly and safe. We advised that the staff fitting rails to the beds should be trained to do so and that regular checks are made of the rails when they are in use, with records kept. The Care Homes for Older People Page 19 of 27 Evidence: deputy manager offered an assurance that this advice will be actioned. The gardens are well maintained and provide a safe and secure area for people to use when they wish to go outside. The fire officer was visiting at the same time as our inspection and reported they had no concerns regarding the fire safety of the premises. We saw that all areas of the home were very clean and hygienic. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the staff have the skills and knowledge to meet their needs. Evidence: People living at the home told us - The staff are very good they look after me very well. People living at the home but unable to comment looked very much at ease and well cared for. People visiting the home told us - The level of care is very good; staff pay attention to detail, my mum is in very good hands. The staff are motivated to speak with the people and there is lots of stimulation. People who completed our survey told us - Staff are pleasant and welcoming, attentive to residents needs, the engagement with residents is very obvious, The staff keep me informed on my mothers condition, they give 100 care at all times, I could recommend this home the staff are a credit to the home. We observed staff carrying out their work in a competent, efficient manner. Staff reacted extremely well when one person became very distressed, staff were able to Care Homes for Older People Page 21 of 27 Evidence: diffuse the situation quickly and calmly. We selected two staff personnel files to look at the recruitment procedures. The files were well presented and contained the information required to safeguard the people living at Samuel Hobson House. The deputy manager stated that recruitment for all grades of staff is ongoing and will continue to do so as the population of the home increases. The Aqaa informs us that - Presently 80 of staff have a National Vocational Qualification (NVQ) level 2 in care and 50 with NVQ3 in care. Staff told us of the training opportunities that they have had recently and includes moving and handling, health and safety, protection of vulnerable adults, food hygiene. The deputy manager explained that training is paramount to providing a quality service. Plans are in hand for comprehensive training to be cascaded to staff and to include mandatory topics as well as specialist subjects. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can have confidence in the care home because it is led and managed appropriately. Evidence: The homes manager has previous experience in running a social care home, the application to be registered as the manager is currently progressing. The manager was not at the service during our inspection. The deputy manager was in charge of the premises and was supported by a care manager of the company. Both people offered their cooperation with this inspection. One person made an additional comment on our survey regarding the management of the home - Manager always visible and approachable, willing to discuss issues/concerns with relatives and then follows them up. Staff told us - We are a new home that is evolving we are working hard to ensure that Care Homes for Older People Page 23 of 27 Evidence: a high standard of care is delivered. The manager is very supportive and helpful. We work well as a team. The deputy manager told us that quality assurance monitoring is ongoing with regular audits being completed each month. The care manager visits the home at regular intervals during the month and completes audits in various subject areas. There is a facility for the service to safe keep small amounts of a persons money. Separate records are maintained for each person and the money is stored individually in a locked safe. We advised that for additional security and accuracy two signatures should be obtained for each transaction. The administrator confirmed that this action will be taken. We saw the records, documents and certificates for the weekly, monthly and annual health and safety checks are being maintained. All requested were readily available for inspection. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 The care plans for pressure area care should specify the creams and lotions that are prescribed for the person. This will ensure that staff have the correct information when providing the care. A nutritional risk assessment should be completed for each person living at the home. This will ensure that staff have full details of the nutritional needs of each person. Protocols and instructions for the safe administration for as required should be available for staff reference. This will ensure that people receive their medications when they need them. The application for the registered managers position of the service should be submitted to the commissions registration department as soon as possible. The transaction documents for the safekeeping of peoples personal monies should include two signatures. This will ensure that accuracy and continuing safety of holding peoples money. 2 8 3 9 4 31 5 36 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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