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Inspection on 14/04/08 for Bings Hall

Also see our care home review for Bings Hall for more information

This inspection was carried out on 14th April 2008.

CSCI 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Bing`s hall is a small, clean, comfortable and homely place, with a stable family atmosphere. One family member said "It`s a lovely place to live for people, who no longer can live at home, my Mother has been happy from the word Go" Residents spoke highly of the staff team that support them, and said that they felt safe living at the home. Care plans are personalised, and contained good detail of individual needs. So the service residents receive is consistent, and as they wish it to be. Personal care to residents is offered in a sensitive and unobtrusive Manner, recognising individuals` preferences.

What has improved since the last inspection?

The service has been registered with the Commission for social care inspection to offer a service to 6 people who suffer from dementia. Staff has attended training in this area in this specialist area of work. The kitchen has been completely refurbished. All residents now have reclining beds to offer residents extra comfort and safety

What the care home could do better:

Overall the care provided to residents was observed to be of a good standard on the day of inspection, but the service would benefit from: Residents being offered a more varied programme of daily activities. Staff supervision sessions and team meetings being recorded to show staff are being appropriately supervised. The current manager registering with the C.S.C.I

CARE HOMES FOR OLDER PEOPLE Bings Hall Chelmsford Road Felsted Dunmow Essex CM6 3EP Lead Inspector June Humphreys Unannounced Inspection 14th April 2008 07:40 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 Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bings Hall Address Chelmsford Road Felsted Dunmow Essex CM6 3EP 01371 820544 01708 501804 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) Family First Residential Care Homes Limited Manager post vacant Care Home 17 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (17) of places Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 16 persons) The double room will only be used to accommodate a couple that have made an active choice to share; this will be clearly documented and a copy will be kept on each person’s file. 1st May 2007 Date of last inspection Brief Description of the Service: Bing’s Hall is a detached two-storey property located in the Essex village of Felsted. Residents’ private accommodation consists of 13 single bedrooms and two double rooms, all of which have en-suite facilities. The home is owned by Family First Residential Care Homes Limited and is registered for 17 Older People over the age of 65 years. (The service is registered for 6 people with dementia) The village of Felsted has shops, public houses and a restaurant. The nearest larger towns are Chelmsford and Great Dunmow. A copy of the most recent inspection report by the Commission for Social Care Inspection was displayed in the entrance hall of the home. The fees charged for this residential care home ranged from £625 to £700 per week. Items not covered by this fee were hairdressing (£5 - £10) chiropody (£10) newspapers and personal items. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This report contains the outcomes of the unannounced key inspection completed on 14th April 2008. Evidence gathered during the inspection included: Observation of interaction between staff and residents, 20 surveys received from residents, relatives, staff, and professionals who have been involved in visiting the home. Individual interviews with three service users and two relatives. An Annual quality assurance assessment completed by the manager of the home, which is a self- assessment now completed every 12 Months by all homes. It is a document that provides a lot of information about the home and what has happened since the last time the service was visited by an inspector. A detailed discussion with the manager, and four members of the staff team on the day of inspection. A look at relevant documentation maintained in the home. Evidence received by the CSCI from the service since the last inspection on the 1st May 2007. The residents seen were happy, and well cared for; having been helped by staff to achieve a high level of personal care. The premises was very clean and odour free. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Overall the care provided to residents was observed to be of a good standard on the day of inspection, but the service would benefit from: Residents being offered a more varied programme of daily activities. Staff supervision sessions and team meetings being recorded to show staff are being appropriately supervised. The current manager registering with the C.S.C.I Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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 Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective Residents can be assured that an assessment will be completed, and admission to the home will only be agreed if their needs can be fully met. EVIDENCE: The current Statement of Purpose and Service User’s Guide has been updated since the last inspection in May 2007, has the home is now registered to provide a service to people with dementia. The guide is easy to read, and contains sufficient information to enable prospective residents to make a choice about whether the home is for them. Three assessments were looked at on the day of inspection and this included an assessment of a person who was not admitted due to requiring nursing care. The quality of the information was clear, precise and outlined the amount of support that would be needed. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 10 One assessment was of a person recently admitted who suffered from dementia. The relative said that “she has been happy from the moment she arrived, and so are all her relations, we are very pleased with the care.” The manager stated that relatives and prospective residents are always encouraged to visit the home before making a decision regarding the admission. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were met by a staff team that showed a caring approach, treating them with sensitivity, dignity and respect. EVIDENCE: Four care plans were looked at as part of the inspection. They were personalised, and contained good detail of individual needs. The care plans had been updated, and were easy for staff to access. Care staff spoken to had a good understanding of the needs of people they were caring for i.e. “they prefer to sit there, and always rise early.” They were observed offering personal care to residents in a sensitive and unobtrusive manner, recognising individual need and preference. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 12 The Manager spoke of good working relationships with all health care professionals. Health care needs were recorded appropriately, and resident said this was positive, as follow up appointments did not get missed. Usually the home tried to provide the same member of staff to go with people to hospital appointments etc as this improved consistency of information received from professionals, but also lowered the anxiety of the resident. The feedback from the surveys received from professionals, was very positive and included comments such as “the staff are knowledgeable and helpful’, and “the residents say it’s a lovely place to live”. The day prior to the inspection a resident had been admitted to hospital. A member of staff was going off to visit the person in hospital prior to going home. A random sample of two service users medication files were looked at and found to be satisfactory. When a new batch/box of medication is opened the date is highlighted on the MAR sheet (medication administration records), and also the box. This makes ease when auditing medication. Controlled drugs have clear practice guidance and the return of medication to the pharmacy is clearly documented. Until recently the service has had medication audited by an independent company. The available funding for this service has now ceased, but the manager felt that an independent audit was highly beneficial and would like to re-instate this service. She currently administers Morning medication Monday to Friday, which she feels is helpful in the current auditing practice. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be supported to live their life in the way they chose, with every effort being made to meet individual needs and preferences. EVIDENCE: The staff, using the care planning process ensures that service users’ personal preferences are identified and recorded. Staff provides, as much support as is required, with residents being encouraged to exercise choice, and maintain autonomy. The staff /carers working in the home provide activities each day. They are usually things that have a personal interest i.e. handicraft, puzzles or games. The activities that were offered, were documented in a file, and if something was enjoyed, or disliked were recorded. However four relatives surveys raised concern about the level and quality of activities, stating some residents were “bored, or unstimulated”. The manager Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 14 advised that not all residents chose to join in. Two residents said that a wider range of activities should be offered. Activities within the community were also offered, such as walks out, and visit to restaurants and pubs. Residents attended church with support from members of the congregation, and a monthly service was held within the home. Monthly entertainment was also offered within the home that appealed to most, and residents had said they liked. The manager showed a picture album that a member of staff had been completing with a resident. This provided a person with focused time with an individual member of staff. This was a very positive piece of work, which would be nice to look at in the future. This is the sort of activities the staff are trying to develop with residents with dementia. Most residents do have relatives and friends who visit. The manager stated that visitors were made welcome, and this was echoed in the surveys that had been returned. There is a small separate room off of the dining area that can be used to provide greater privacy if required. The food provided is nutritious, varied and well balanced. The menu is a sixweek menu, but should a resident make a request for a particular food that is not offered then every effort is made to provide it. An example of this is the resident who said she would like to have fish roe. The manager had a discussion with other residents in the room, and it was decided that this maybe available at the fish counter of the local supermarket. There is a cook, and an assistant that works in the home most days. Residents have individual breakfast cards, and huge ranges of different requests were catered for. Four residents were spoken to, and asked about the quality of the food. Three said “very good”, and one said “good enough for me!” Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that their complaints will be listened to sympathetically and responded to. EVIDENCE: The complaints procedure is on display in the entrance hall along with a range of advocacy information. The latest inspection report was also available. The complaints book was viewed as part of the inspection. The last recorded complaint was received in April 2007. The proprietor had been informed, and chose to investigate the residents concern. The manager advised that it had been resolved satisfactory. However it was unclear if the resident or relative had received an appropriate response, and within agreed timescales. The manager agreed to produce a complaints form to attach to the back of the current complaints letter, and ensure timescales, and outcomes are clearly documented. Six residents surveys said that staff are always available when needed, and staff always listen and act on what you say. This was followed at inspection by speaking to two of the residents who had already completed a survey. One resident said, “My daughter visits regularly, and speaks to the Manager. If I was unhappy about something I would tell her”. Another resident said, “the Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 16 manager is around most days, and if she is not then Lyn the owner is often in, I would complain to them”. The acting manager had recently been on holiday, and all senior carers were familiar with the policies and procedures of the home, and the location of all the documents including those relating to safeguarding. Safeguard training is part of the home’s mandatory training programme. All staff spoken to had attended training, and had sufficient knowledge to respond to any possible concerns. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a well maintained and attractive home that meets their individual needs. EVIDENCE: The accommodation is of a good standard and was in good order throughout. The kitchen has been completely refurbished since the last inspection. The manager also stated in the annual quality assurance assessment that five further adjustable beds had been purchased to maximise comfort and safety. All residents now have these beds. One resident said, “these beds are great, I like to read in bed, and they can be adjusted just as I like.” The staff at Bings Hall has worked hard to make the home environment, look and feel like a home. There are residents’ personal belongings throughout the Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 18 building, and pictures on the wall. All of the residents have personalised their bedrooms with their own pictures and other individual/personalised belongings. All of the bedrooms are single rooms, except for one room that is currently being shared by a married couple. All have sufficient furniture, a wardrobe etc and are uncluttered, and no concerns re safety, i.e. possible trips and falls. There are number of communal areas for residents to use, which includes the lounge, a smaller separate room for individualised activities, or meeting with visitors, and a large dining area. There is also a room that is used for hairdressing and chiropody. The gardens are very attractive, and although the patio was in need of a clean on the day of inspection, it is well designed to enable all residents to use it if they so wish. Several residents said that they really liked to sit out in the summer, and there was always staff to hand to assist them. The proprietors have yet to fit ramps to access the Patio area has discussed in previous inspections, and although this would allow access for some residents without staff support, it is not a hazard and therefore no requirements has been made. The proprietor employs a range of staff to look after the premises including a gardener and a cleaner. The laundry and sluice facilities are sufficient to meet the needs of the residents. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by committed, trained staff that receive regular updating to enable them to carry out their jobs safely and effectively. The recruitment process is in accordance with current legislation, and includes all the relevant checks to protect vulnerable people. EVIDENCE: The staff on duty were observed working well together. There was a sense of teamwork and responses to residents were caring and consistent. Sufficient numbers of staff were on duty to meet current residents assessed needs. If further residents were admitted who require greater care, then the manager gave assurance that staffing numbers would be reviewed. Staff surveys were positive about the support provided by the manager, and the senior staff within the team. One person said, ”we are a team and work together, but the manager is always available to help and advise” The manager advised that no agency staff were used; shifts were covered by the staff in post. Staff spoken to say they had been in post for a considerable Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 20 period of time, and that this made a difference to the quality of care that they were able to provide to residents. This was also re -stated in three surveys returned by relatives who stated, “The attitude to residents is exemplary”. “There is affection, a willingness to help, interest in individuals and above all respect”. The home has an excellent record in both N.V.Q training, and also mandatory training, including update /refresher courses. The annual quality assurance assessment stated that at the time of completion that all staff had completed N.V.Q 2 or higher. Staff interviewed said that every effort was made to assist in staff training, and a young staff member said, “The management are very flexible in trying to provide shifts that can fit around training”. The records of all of new staff currently in post were inspected and found to hold all of the required checks and information i.e. criminal record disclosure and references. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 31,33,35,36 and 38 This judgement has been made using available evidence including a visit to this service. The home is organised and managed in a way that puts the residents at the centre of the decision- making process, their care and safety is the principal focus of the home’s procedures. EVIDENCE: The management of the home is effective in ensuring that changing needs of residents are assessed and met, and that the home is meeting its expressed aims and objectives. The information received from relatives surveys suggested that levels of communication was good, and further discussions undertaken on the day of inspection indicated that relatives and residents consider the manager to be “an effective leader”. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 22 The overall standard of record keeping is good and this enables consistency in the service provided. Records seen at this inspection were well maintained and included health and safety practices in the home, regular tests of fire alarms and equipment, electrical and equipment maintenance. COSHH products are kept in a cupboard, which has a lock on it. Staff ensures products are put away when not in use. A sample record of financial transactions made on behalf of residents found to be in order with a robust system of checks and balances in place. Fire drills and tests of fire systems had been carried out regularly, along with the sample of other health and safety documentation i.e. regular building checks. The home has a freelance practitioner who is involved in ensuring the home has appropriate quality assurance methods. Surveys have been sent out since the last inspection in May 2007 and the responses received again praised the care and support provided to residents living in the home. Despite the very positive comments throughout the inspection both from residents, relative and staff there are two areas that require management attention. The Records of team meetings, and four staff supervision files were looked at including the managers. There was a significant lack of evidence to show that supervision meetings or team meetings are regularly occurring. Whilst we can appreciate that in a small home there is greater opportunity to communicate verbally the above professional practices are considered good practice within the care home. The manager has also yet to registrar with the commission for social care inspection, despite previous discussion with the previous inspector in 2007. This also requires priority. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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 x x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action 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. 3. Refer to Standard OP12 OP31 OP36 Good Practice Recommendations Residents daily activities should be reviewed, to ensure that the needs of all people are considered, including resident suffering with dementia. The provider should ensure a registered manager is in post, by the manager registering with the C.S.C.I. The manager must ensure that appropriate levels of supervision and team meetings are implemented and recorded to ensure staff continue to provide high quality care to residents. Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Bings Hall DS0000030469.V362035.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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