Inspection on 15/09/05 for Belmont Villa Care Home

This inspection was carried out on 15th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Belmont Villa Care Home 27/09/07

Belmont Villa Care Home 22/08/06

Belmont Villa Care Home 23/11/05

Belmont Villa Care Home 01/03/05

Belmont Villa Care Home 29/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Belmont Villa Nursing & Residential Home 58-62 Weymouth Road Frome Somerset BA11 1HJ Lead Inspector Barbara Ludlow Unannounced Inspection 10:50 15 & 28 September 2005 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Belmont Villa Nursing & Residential Home Address 58-62 Weymouth Road Frome Somerset BA11 1HJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01373 471093 Belmontvilla@aol.com Belmont Villa Residential & Nursing Home Ltd Mrs Sharon Welsh Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to 27 places for elderly persons of either sex, not less than 60 years, who require general nursing care. Up to 5 places for personal care Up to five persons of either sex, in the age range 18-59 years, who require general nursing care. 1st March 2005 Date of last inspection Brief Description of the Service: Belmont villa is a family run Nursing and Residential Care Home set in a residential area of the town of Frome. The home is registered for 32 service users. There are twenty-seven places for the provision of nursing care (includes one twin room that can be used by married couples or those wishing to share) and five places for residential care. The service is set in two joined Victorian houses. The residential care area is in one house and nursing care the other. Both houses are designed to meet the needs of the service user groups. Currently there are twenty-nine single rooms with en-suite facilities. The service has four bathrooms, two shower rooms and eight separate WC’s. In addition there are five day/quiet rooms. The service also has accessible gardens to the rear. All laundry is done “in house”. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on two days. The first day was undertaken by one inspector and commenced at 10.50am until 6pm. The Manager spent a significant amount of time with the inspector assisting with the inspection process. From the last inspection it was confirmed that the floor covering in the kitchenette had been replaced. There were 29 service users in residence in total; this was 21 nursing category and 8 residential category service users. A tour of the premises was made and 18 service users and 5 staff were seen. Service users who were able to respond were asked for their views on the care service offered at the home. Service users were generally satisfied with the care they receive and no complaints were heard. One person stated that they would like to get out more. Records were sampled, these included care plans, staff recruitment files, financial contracts and servicing and maintenance records. The home had received an instructive visit by the community pharmacist in June 2005 and yet the management of medications was seen to be poor and advice was given for immediate attention to the deficits seen. The Manager arranged a trained nursing staff meeting at the time of the inspection, to address the deficits. Following consultation with the CSCI Pharmacist a second visit was made by both the Regulation Inspector and the CSCI Pharmacist Inspector, this was to assess any outstanding issues and offer further advice to improve practice. Mr Brown forwarded pharmacy information documents for the attention of the Manager and her registered nursing staff to the home. On day two of the inspection improvement was seen, the Manager is keen to ensure a good standard of practice is achieved and upheld. Health and safety issues arising were identified for attention and by the second day of the inspection these issues were confirmed as having been addressed. No immediate requirements were made on the second and final day of the inspection. What the service does well: Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 6 Belmont Villa offers a good level of comfortable accommodation. The nursing home has wide corridors and a large lift, this part of the home was purpose built internally to meet nursing care needs. The dining room was fully refurbished between inspection visits to a very good standard, all dining furniture was replaced. The residential area is smaller, homely and comfortable. There is a small lift for access to the first and second floors. The home has good relationships with the local community health care services and local hospital. The homes management are enthusiastic and keen to develop the service they offer. What has improved since the last inspection? What they could do better: The management of medication required further action; this was discussed on the second day of the inspection. On the first day, cleaning was identified for attention and the waste bins some did not have lids, these areas were not re-inspected on the second inspection day but the inspector was informed that they had received the Managers and staff attention. Care plans were identified that required more frequent reviews. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 7 An early announced inspection has been agreed to monitor progress and ongoing practice. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5, NMS 6 does not apply. The home has a Statement of Purpose and Service User Guide to assist prospective service users to make an informed choice. Visits to view the home are welcomed. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide (last revised in April 2005) copies are held by CSCI. Contracts were not examined at this inspection. Fee rates were increased in April 2005 and Nursing places are £625.00 excluding the Free Nursing Care contribution. The home does not offer an intermediate care service, however, social services have block-contracted places known as ‘step down’ beds for persons leaving hospital and requiring 4 to 6 weeks care. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 10 The home receives the single assessment process paperwork for these service users and all new admissions to the home. The homes Manager would assess potential service users for their suitability for the home to ensure that care needs can be met. Examples of community care reviews were seen on the care plans sampled. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The care plans must be audited to ensure that reviews are made when required and at the specified times. The home has good relations with the local healthcare services. Medications management in the home has the potential to put service users at risk and should be monitored to ensure best practice at all times. EVIDENCE: The home has good communication with the local hospital and community health care services. The home also benefits from having a regular weekly visit from one of the local GP practices; this provides an opportunity for regular reviews of care and medication for the service users registered with this practice. Care plans are in place for all service users. Five care plans were seen and the following findings were noted: Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 12 A good level of personal information and contacts were recorded. Waterlow scores are made to determine pressure sore risk, in two care plans the scores had not been recently updated. Regular weight monitoring had not been undertaken where a service user was reported to be immobile. Moving and handling assessments are made; two had not been reviewed by the date set, July 05. Care had been documented for specific care needs such as catheters. Bed rail reviews were not carried out on the planned date for one service user. Warfarin treatment was recorded in the service users own book but there was nothing entered onto the care plan to demonstrate current management. The input by the service user or their family/carer into the care planning process was not evident on the care plans sampled. Daily entries were found to be informative and helpful. One service user complained to the inspector about needing new spectacles and was found to have acquired someone else’s. The Manager dealt with this at the time of the inspection, it is important that staff take account of such events to ensure service users all have their own spectacles and enjoy their optimum vision. The deficits found on day one were not re-inspected on day two. Medication deficits were identified on the first day and were discussed with the manager. These deficits included date expired: creams, eardrops and sterile equipment, all were taken out of use at the inspection. CSCI pharmacist Mr Brain Brown was consulted and up to date written guidance and information was posted to the home without delay, to aid the improvement of medications management. A second visit was arranged for 28/09/05, the findings were: • • • • Opened on and discard by dates were not always recorded on eye drops and skin creams. Self-medication requires the monitoring of supply. Variable dose medicines, it should be noted how many tablets are dispensed each time. MAR charts require to have the date and quantity of medicines received recorded on them. DS0000003242.V254434.R01.S.doc Version 5.0 Page 13 Belmont Villa Nursing & Residential Home • • • • • • • • The oxygen warning sign needed to have more information on it. The medicines fridge temperature needs to be monitored as a minimum and maximum and recorded daily. Some items for blood sugar monitoring were out of date. It was recommended that the Manager speak with the diabetic specialist nurse directly to access up to date information on blood sugar monitoring. It was noted that the suction machine did not have a PAT test sticker on it to demonstrate annual safety inspection. The syringe driver is seldom used but should be calibrated and be ready for use. Confirmation of safe transfer of medicines waste was discussed. Controlled drugs management was satisfactory. Oxygen cylinders that had been unsecured on day one had been secured at the follow up inspection day two. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Service users asked said they were satisfied with the care they receive at the home and commented that ‘everyone is very kind’. Service users were seen to have visitors and the inspector heard that, ‘The food is good.’ EVIDENCE: Service users were seen in the lounges and in their own rooms during the inspection. A small number of service users were seen at teatime in the dining room. There did not seem to be much going on at the first inspection day, many service users require assistance and would need to have activities tailored to meet their individual needs. The home offers some activities and trips out which include visits to the park opposite the home when the weather is warm and dry. The inspector heard that one service user would like to go out more. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 15 One residential service user regularly attends a day centre, another the local church. The homes Manager leads the monthly religious service at the home. The Manager confirmed that she is hoping to find a pianist to assist at the harvest and Christmas services. Care staff do offer one to one attention to service users during the afternoon, it was felt that this could be developed. The service users have their meals in the homes dining rooms but can if they choose eat in their rooms. One service user confirmed that ‘the food is excellent’, others said it was ‘good’. One service user confirmed that they have a pureed diet. Dietary requirements are recorded in the care plans. Tea served on day one in the dining room was, mushroom soup, macaroni cheese, cake, ice cream and a cup of tea. Service users not only commented on staff kindness but also that ‘you can get up and retire when you want’. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home has a clear complaints procedure. EVIDENCE: The home has a complaints procedure; a copy is included in the service user guide. The home and CSCI have not received any complaints about the service. One service user confirmed that they would feel able to raise any concerns they might have, with the Manager. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The home is suitably adapted to meet the needs of the service user groups of older persons requiring nursing or residential personal care. Requirements were made for health and safety and infection control issues on the first day of this inspection and these have been addressed. EVIDENCE: Belmont Villa provides spacious accommodation both in bedrooms and communal rooms, 29 bedrooms have en-suite facilities. The home has adapted bathing facilities and sufficient toilet facilities. The nursing accommodation was clean and tidy; one bedroom on the residential side of the home was in need of deep cleaning. Significant Health and safety deficits were detected and remedial work has been undertaken between the two inspection visits. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 18 Six wardrobes were seen that were not secured from toppling forwards and causing injury, these were identified to the Manager who confirmed that action had been taken to secure them, this will be checked at the next inspection. Three windows above ground floor level were seen that were not restricted in opening these must be risk assessed or restricted for the health and safety of the service users. One bedroom dressing table was in poor repair with two broken drawers. The communal areas were clean and tidy although one soiled tablecloth on a side table was seen and two bed tables that required cleaning and repair or replacement. The decoration was poor in the dining room on the nursing wing, between inspection days this was scheduled re-decoration and refurbishment was carried out which included new dining tables and chairs. The decoration in the conservatory is damaged but this room is scheduled for re-decoration. The carpet, which was identified as loose, and a trip hazard was refitted after the first inspection day. Some areas did not always have liquid soap, paper towels and a lidded waste bins, these areas included the treatment room, sluice and some bedrooms. It is essential to have all three components to ensure hand washing can be readily undertaken. The Manager confirmed that she intended to address this promptly; the treatment room had been properly equipped on day two of the inspection. Bar soap and flannels were seen in one bathroom, these may have been recently left there, however, care is advised to ensure this does not occur for infection control purposes. Bedroom doors are kept closed; one service user commented that they would like to have a special device to keep the door open. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The home had a sufficient staff number on the duty at this inspection. CRB checks are required at this inspection for overseas recruited staff in addition to the ones completed at their country of origin. EVIDENCE: The home has a number of overseas staff that are qualified as nurses in their own countries increasing the skill levels at the home. Staff are encouraged to undertake NVQ training and attend study days. The recruitment files for new staff were examined and all staff except the overseas staff had CRB checks. The Manager had understood that their Police check from their home country was sufficient. The home is CRB registered body and it was required that CRB checks are carried out for all overseas staff as soon as possible. One member of staff had completed a CRB but had commenced working at the home before this was confirmed as satisfactory, in this instance a POVA First check could have been requested, this should happen in all future practice where staff are required to start work as soon after their interview. Staff have supervision and dedicated time is being timetabled to incorporate this as routine practice. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 20 The home has an NVQ Assessor for 14 hours per week to provide staff support, mentorship and training. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,37,38 The home has an experienced Registered Nurse Manager. The Manager meets with staff and service users and welcomes suggestions from service users and their families and CSCI for improving the service. Records were stored safely and appropriately. Areas for attention to Health and Safety were highlighted under Environment in this report; attention has been given to address the identified deficits. EVIDENCE: The Registered Manager is a First Level Registered General Nurse with considerable experience managing both the nursing and residential home. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 22 The Manager will be undertaking the Registered Managers Award at NVQ Level 4. The Manager impressed with her enthusiasm and willingness to address the deficits that were detected at this inspection. Considerable efforts had been made between the inspection days to remedy some of the faults and to undertake redecoration and environmental improvements in the dining room. All records required and checked at this inspection were stored safely and appropriately. The office space is well managed. The manager confirmed that the home is viable and investment in the home was evident. Hoists had been serviced and labels read 08/05. The environmental deficits detected are detailed in the Environment section for NMS 19 to 26. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 X X 3 1 Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Medications must be improved in line with the deficits reported that included: Appropriate Oxygen warning signage is required. The home must ensure that a record is made of the administration of medicines to all service users. This applies to the administration of variable doses, the application of creams and the supply of medicines to those service users looking after their own medication. The home must ensure that all sterile products and medicines are disposed of once the expiry date is reached. This also applies to products with a reduced shelf life after opening. All medication must be stored at the required temperature and temperature records must be kept. Timescale for action 17/11/05 Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 25 The home must ensure that all medicines for disposal are returned and disposed of legally. Syringe Driver must be recalibrated before use. The suction machine must be PAT tested as a minimum. 2 OP29 19(1)(b) Schedule 2 CRB’s/POVA First checks must be 17/11/05 carried out for all staff at the home and all new starters. Action taken between inspection days must be confirmed with the inspection response. Care plans must be reviewed and 17/11/05 service users must be more involved with their care planning. Wardrobes must be secured. 17/11/05 Windows must be risk assessed and restricted as necessary. Action taken between inspection days must be confirmed with the inspection response. 3 4 OP8 OP38 14(2) 15(2) 13(4)(c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP26 OP12 Good Practice Recommendations The home should be monitored more closely to identify when deep cleaning is required. The activities programme should be developed and include more meaningful input by staff when spending one to one time with service users. Belmont Villa Nursing & Residential Home DS0000003242.V254434.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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