Inspection on 21/08/06 for Birchwood Grove

This inspection was carried out on 21st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Birchwood Grove 12/10/08

Birchwood Grove 09/10/07

Birchwood Grove 12/04/07

Birchwood Grove 15/11/05

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

CARE HOMES FOR OLDER PEOPLE Birchwood Grove 64 Sydney Road Haywards Heath West Sussex RH16 1QA Lead Inspector Mrs S Rodgers Key Unannounced Inspection 21st August 2006 11:00 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 Birchwood Grove DS0000065773.V301765.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. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchwood Grove Address 64 Sydney Road Haywards Heath West Sussex RH16 1QA 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) 01444 458271 01444 441 792 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Mrs Jacqueline Ferguson Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24) of places Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Birchwood Grove is a care home providing personal care and nursing for elderly persons with dementia and other mental disorders. The home admits residents from the age of 50 years upwards provided they are assessed as requiring care for mental health problems. The registered providers are Ashbourne (Eaton) Limited. Birchwood Grove is a large detached house in a residential area of Haywards Heath; 5 minutes walk from the local railway station and town centre. The residents accommodation is situated on the ground and first floor accessed by a passenger lift. There are 20 single bedrooms and 2 double bedrooms, 14 of which offer en-suite facilities. There are two lounge and dining areas and a garden at the rear, which is accessible to the residents and limited parking space to the front of the property. The weekly fees are £650 to £675. Extras include hairdressing, chiropody and newspapers. The home inspection reports are displayed in the hallway of the home along with the Statement of Purpose and Service User Guide. The responsible individual on behalf of the company is Mrs Angie Knight. Mrs Jacqueline Ferguson is the registered manager responsible for the day-to-day running of the home. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on one day in August over a 5 hour period. The providers/manager were required to complete a pre inspection questionnaire; this document was submitted to the Commission with accompanying documents by the due date. Information from this questionnaire will be included in this report. Resident surveys were also sent in order that residents were able to express their views on the service. Four were returned having been completed by relatives, comments form part of this report. Preparation for this inspection focused on a reviewing pre inspection material, reviewing surveys, review of previous inspection reports, provider’s monthly reports and general correspondence. During the course of the inspection the inspector toured the home, observed interaction between residents and staff in order to gain a view on the services provided. It was noted that the atmosphere within the home was jovial and relaxed and that the staff carried out their duties in a respectful manner taking into account the dignity and privacy of residents. Two visitors were also spoken with in order to gain their view of the service their relatives receive. One staff were spoken with in order to gain a sense of the support and training received in order to carry out their jobs and to gain insight into how their knowledge of the aims and objectives of the homes philosophy of care. From speaking with residents the inspector gained the impression that the care provided by the management and the care team is of a good standard. There were two requirements and one recommendation identified at this visit. An action plan should be submitted by the 11 October 2006 advising the Commission of action taken/to be taken and timescales in which compliance with the regulations will be achieved. What the service does well: Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 6 The service provides residents with an environment in which they can develop a lifestyle suited to their needs, for example residents can walk around all communal areas of the home as they wish. Staff are provided with training to enable them to understand the needs of residents. The service provides residents with a well-balanced, nutritious diet. The current care plans ensure that staff are aware of the needs of residents that enables them to provide a consistent level of care. What has improved since the last inspection? What they could do better: Blinds or curtains must be fitted to the bedroom doors that have a glass window in them this is to promote and ensure that the privacy and dignity of residents is maintained. Armchairs in the lounge/dining room would benefit from being cleaned. The quality monitoring and quality assurance audit must be collated into a report that is published and be available to any interested parties. Birchwood Grove DS0000065773.V301765.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. Birchwood Grove DS0000065773.V301765.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 Birchwood Grove DS0000065773.V301765.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The services Statement of Purpose and Service User Guide have been updated to reflect the changes of service provider. The pre admission assessment enables the management to determine that the needs of person admitted to the home can be met. Intermediate care is not provided. EVIDENCE: The homes Statement of Purpose and Service User Guide are displayed in the hallway of the home. The documents have recently been updated to reflect the changes in ownership. The documents clearly record services provided to assist prospective residents, relatives and placing social worker to make an informed decision as to whether the service will be able to meet their needs. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 10 Pre admission assessments seen at this visit demonstrated that prior to moving into the home a senior member of the care team, usually the manager undertakes an assessment of the prospective resident to ensure that the service can meet their needs. Prospective residents and/or their relatives are given the opportunity to visit the home and meet staff. A four-week trial period is offered so that they have the opportunity to ‘test run’ the service prior to making the decision to move into the home permanently. Four surveys were completed and returned to the Commission by relatives. All confirmed that they felt that they were provided with sufficient information about the service prior to their relatives moving in. Intermediate care is not provided. Birchwood Grove DS0000065773.V301765.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care needs of residents are documented in individual Care Plans, which enables staff to monitor and maintain continuity of care. Systems are in place for the safe handling of medication. Resident’s privacy and dignity is maintained. EVIDENCE: Four care plans were reviewed. Care plans are initially started using the information gained at the pre admission assessment. Reviews take place monthly and any changes in care provision are recorded. Care plans provided information for staff to assist them to deliver a consistent standard of care and to ensure that all health care, mental health and the social needs of residents are met. A record of doctors visits and visits from other health professionals are recorded along with any agreed treatment. Relatives have agreed and signed the care plans on behalf of their relative. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 12 Comments received regarding care and supports were generally positive. ‘Staff are always helpful and willing to do all that is needed and communicate with relatives. One relative commented that in the early stages, the support received by their relative was not up to standard on the first day of admission ‘later I went back, when I visited my relative was just wandering around completely confused, after the social worker did 6 week review I did get an apology but it shouldn’t have happened. The staff are all very good and cope very well with difficult residents.’ Residents are not able to take responsibility for their own medication. Trained nurses are responsible for administering all medication. The medication administration records seen at this visit were in good order. The inspector observed staff to be respectful of resident’s privacy. They ensured that doors were shut when personal tasks were being undertaken with residents however, when touring the home the inspector noted 4 rooms that have a glass observation window. There were no curtains or blinds to draw across to maintain the individual’s privacy whilst/should personal care is carried out in their rooms. A curtain or blind must be fitted to ensure to each of these windows in order that the dignity and privacy of the persons occupying these rooms are maintained. Birchwood Grove DS0000065773.V301765.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A limited programme of activities is provided. Residents are assisted to maintain contact with family, friends, and representatives and access the community. Residents are assisted to exercise choice over their daily lives. Residents are offered a wellbalanced and varied diet. EVIDENCE: Since the last inspection the position of activities co ordination has become vacant. Mrs Ferguson advised the inspector that she intends that the activities hours be reallocated to care team who will then undertake the activities. There was a mixed response from relatives as to whether there are enough activities provided comments included ‘not enough activities’, ‘Recently they have had 2 entertainments by couples who sing the old songs etc which the residents enjoyed greatly. The lady who brings in her pet dog is a great hit with the residents. One of the care team was playing skittles with the residents in the lounge – hard work but a few managed it and enjoyed it. I appreciate that some activities are impossible for some, my husband will not join in everything but if the activities happened more regularly it would encourage participation.’ And ‘He enjoys all activities’. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 14 Visitors spoken with at this visit confirmed that they are to visit their relatives as and when they wish. They confirmed that they are made to feel welcome. The homes Statement of Purpose informs relatives of their commitment for continuing contact with family and friends. The document also advises them that relatives meeting and a weekly home managers surgery are available to relatives to attend if they wish. Due to the diverse needs of resident it is difficult for residents to maintain full control of their own lives however, during the visit the inspector was able to observe that residents were able to make use of all communal areas within the home and were not stopped from going where they wanted unless there was risk of an accident to themselves or other. Since the last visit a chef has been employed by the service. The midday meal seen on this visit looked appetising, well balanced plentiful and hot. The inspector noted and was impressed by the detail of garnishing resident’s food that enhanced the presentation of the meal. A four-week menu plan was submitted with the pre inspection material. Special diets are catered for as required. A number of residents require assistance with feeding, the inspector observed staff to sit beside residents and talk with them, each staff member only feed one person at a time. Following the last visit the and in line with Environmental Health Officers recommendations the missing tiles in the kitchen have been replace. The chef confirmed that there are plans to renew the floor covering in the near future. Comments from visitors spoken with on the day and comments from surveys were as follows, ‘the food is excellent’, ‘my husband has a very good appetite and enjoys his food. He does not like pasta he is an old-fashioned meat and 2 veg man. The new cook is super and she will always arrange an alternative is possible’, and ‘he especially enjoys the food at Birchwood Grove – and I think it is excellent too’. Birchwood Grove DS0000065773.V301765.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints system is in place. Systems are in place to protect residents from abuse. EVIDENCE: There is a clear complaints procedure, which is included in the Statement of Purpose and Service User Guide. The procedure clearly identifies whom a complaint should be addressed to and the timescales in which a complaint will be dealt. The surveys received from relatives and relatives spoke with at this visit indicated that they know how and to whom to make a complaint. The homes complaints record was available. There has been 1 complaint within the last 12 months that was dealt with within the allocated timescales. Staff receive training in adult protection. The home has a copy of the local authorities Adult Protection procedures. Staff are aware of their responsibility to “Whistle Blow” should they suspect abuse of a resident. Staff spoken with during the course of the inspection demonstrated that they know what action they must take to report a suspected incident. They were also aware of the types and indicators of abuse. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 16 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): 19,26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained. The standard of cleanliness throughout the home was adequate. EVIDENCE: Whilst touring the home the inspector was able to establish that the physical environment is well maintained and meets the needs of the current residents. The pre inspection questionnaire indicates that some bedrooms have recently been redecorated and new dining area has been made which has had new flooring laid. Since the last inspection redecoration and renovation to the outside of the property has started. The standard of cleanliness throughout the home was adequate. Some armchairs in the small sitting room were grubby; the inspector was advised that plans to renew these have been included in the budget. The inspector Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 17 advises that the armchairs in question should be cleaned in the short term as they are unpleasant to sit in and may be the cause of the unpleasant smell that a relative has commented that this room has sometimes. The inspector was informed that due to staff sickness the homes domestic was not available and that the laundry assistant does the cleaning in the afternoon. This resulted in some parts of the home looking unkempt until later in the day. One comment Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 18 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 quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were on duty in sufficient numbers to meet the needs of the current resident. The skill mix of staff was observed to be appropriate. There is a recruitment procedure in place. Staff are encouraged to undertake training appropriate to the need of resident. EVIDENCE: Information submitted with the pre inspection material and duty rotas seen at the inspection indicate that staff are employed in sufficient numbers to meet the needs of the current residents. There is generally 1 trained nurse and 3 carers on duty during the morning, 1 trained nurse and 3 carers during the afternoon/evening and 1 trained nurse and 2 night care assistants during the night. Records seen and staff spoken with at this inspection evidence that staff receive induction training and are offered the opportunity to undertake a National Vocational Qualification. The pre inspection questionnaire demonstrates that 38 of care staff have obtained a National Vocational Qualification in care level 2 or above. The manager is aware of the requirement to have 50 of care staff with a National Vocational Qualification Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 19 level 2 or above and in fact at the last inspection exceeded this target. A requirement has not been made in respect of this standard as the service is working toward staff gaining this award. A recruitment procedure is in place. Staff complete an application form, attend an interview and references, Enhanced Criminal Record Bureau checks and a check against the Protection of Vulnerable Adults register are undertaken prior to any new employee commencing employment. It was confirmed and documents record that staff receive induction programme that records the competencies that are assessed by a senior member of staff and is signed off when the new staff member has demonstrated that their competence. The staff member spoken with at this visit confirmed that he is currently on an induction programme and that he has received other training such as Dementia awareness, Adult protection, and manual handling updates challenging behaviour and fire safety instruction. It was confirmed that staff are able to share their views with management via staff meetings and supervision. Staff were observed to be relaxed, confident and competent. The inspector noted that they were also respectful when talking or assisting residents. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being managed in an appropriate manner. The financial interests of residents are safeguarded. Resident/relatives views are sought. The health and safety of residents is promoted. EVIDENCE: Mrs Jacqueline Fergusson the registered manager is a Registered General Nurse. She also holds a Registered Managers Award. Staff a spoken with confirmed that they are able to approach her with their views and concerns, and that they feel that their views are taken into consideration. Relatives are Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 21 enabled to maintain regular contact with the manager via the relatives meeting and the open surgery meetings. The management do undertake a number of internal audits and have recently sought the view of stakeholder (residents relatives) however the information from these audit have not been collated into a report to demonstrate that they continue to meet the aims, objectives and Statement of Purpose for the home. An annual development plan should be devised based on a cycle of planningaction-review reflecting the aims and outcomes for residents. The homes policy is not to get involved in handling personal finances however, Mrs Ferguson is appointee for one resident who is unable to take control of her own finances and does not have a relative to do so on her behalf. Records of incoming and outgoing payments are kept and were available for inspection. Money can be held in safekeeping for residents. Records seen were in good order. The pre inspection questionnaire demonstrates that systems and equipment are serviced at regular intervals. All accidents, incidents and injuries are recorded and reported to the appropriate authorities. Fire safety records indicate that all staff have received fire safety instruction at the recommended intervals of 6 monthly day staff and 3 monthly night staff. Regular fire safety checks on fire equipment are undertaken. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 22 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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 OP10 Regulation 12 (4) Requirement Curtains/blinds must be fitted to the bedroom doors with window in them to ensure that the privacy and dignity of residents is maintained. The registered persons shall establish and maintain a system for reviewing and improving the quality of care provided at the care home. Timescale for action 12/10/06 2 OP33 24 12/10/06 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 Refer to Standard OP26 Good Practice Recommendations The armchairs in the lounge/dining room areas should be cleaned. Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southampton HO 4th Floor, Overline House Blechynden Terrace Southampton Hampshire SO15 1GW 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. Extracts may not be used or reproduced without the express permission of CSCI Birchwood Grove DS0000065773.V301765.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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