CARE HOMES FOR OLDER PEOPLE
BROADWATER LODGE Higham Road Tottenham London N17 6NN Lead Inspector
Karen M Malcolm Unannounced 20 & 23 June 2005 @ 10:00 am 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 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. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Broadwater Lodge Address Higham Road, Tottenham, London, N17 6NN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8808 6070 Mary Hennigan for London Borough of Haringey Miss Sylvia Anne Beaumont PC Care Home 45 Category(ies) of OP Older People registration, with number DE(E) Dementia over 65 of places BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To provide intermediate care to a maximum of 9 of the 45 service users of either gender who are aged 65 years or older. Accommodation for this service is to be restricted to the dedicated unit on the ground floor. The unit must have a team of staff specifically dedicated to it. Any individual service user`s stay within the unit should not be any longer than six weeks. 2. The provider must undertake a programme of measures that will achieve full compliance with National Minimum Standards for Older People by 1 April 2005. Standards 19 to 26 - Environment, or those equivalent Standards that may be published at the time, as required by Regulation 23(1)(a); 23(2)(a to p); 23(4)(c) and Regulation 16(2)(c)(g)(j)(k) - by 1st April 2005. 3. The provider must ensure that the home complies with all requirements contained in the relevant Health and Safety legislation by 1st April 2005. and further must undertake a programme of measures that will achieve full compliance with National Minumum Standards for Older People - Standard 38 Safe Working Practices, or those equivalent Standards that may be published at the time, as required by Regulation 23(1)(a); 23(2)(a to p); 23(4)(c) and Regulation 16(2)(c)(g)(j)(k) - by 1st April 2005, in order to promote the health and safety needs of service users. Date of last inspection 16 November 2004 BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Broadwater Lodge is a purpose built home run by the London Borough of Haringey, providing care for up to 47 people who are elderly. Some residents have additional physical disabilities and mental health needs associated with ageing. The home is on three floors, with two living units on each floor. One unit provides care tailored to the needs of Elders from the Caribbean Community, and one unit has been refurbished to provide nine intermediate care beds. The stated aims of the home are to enhance the dignity, self-respect and individuality of each resident. In addition to providing care for its residents, and access to medical professionals as required. activities are provided by an activities co-ordinator. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over two days. The manager and a senor member of staff assisted the inspector throughout the inspection. In the home apart from the registered manager were three assistant managers, nine carers, the cook, the assistant cook, four domestics, one laundry assistant, the administrator and the handy person. Four service users are in hospital and there are two vacancies. The inspector was able to speak to a number of service users and one relative who was visiting on day one. Feedback given was very positive about the environment, the staff and the care and support given to the service users. The inspection involved sampling a number of care plans, records and a tour of the building and observing the interaction between staff and service users, which was friendly and caring. The manager and all staff the inspector met were very open and helpful throughout the inspection. What the service does well: What has improved since the last inspection?
Since the last inspection there were four areas for improvement and one recommendation. Two areas of improvement and one recommendation have been met. These both relate to the manager ensuring that the care need of
BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 7 service users who reside in the home can be met. Evidence of this was on the care plans examined. What they could do better: 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. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3 & 6 Prospective service users are have the information they need to make a choice about where they would like to live through the publication in place. Service users are assessed prior to moving into the home, therefore ensuring that the correct care and support is put in place prior to moving in. Each service user receives a contract that ensuring that the home’s terms and conditions are upheld. EVIDENCE: The home’s Statement of Purpose and service user guide are comprehensive and clear. Both documents are impressive and the inspector commended this. Some amendments were required at the previous inspection, and prior to this inspection a copy of the amended documents were submitted to the CSCI. However, there were still a number of amendments needed on the Statement of Purpose namely: • A list of all room sizes to including the lounge and the kitchen etc.… • Qualification of the registered provider • Gender range of service users who reside in the home. The home has comprehensive systems in place to assess new service users, who have the opportunity to visit prior to admission if they wish.
BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 10 At the previous inspection it was recommended that the responsible persons ensure that the care home is suitable for the purpose of meeting service users needs in respect of health and welfare. The manager stated that this related to a specific service user who was Turkish speaking and the home was unable to meet the service user needs at the time, due to the language barrier. The manager stated that the specific service user has now moved out of the home, to a more appropriate service. It was also required at the previous inspection that the home’s Conditions of Registration have been changed to reflect the refurbishment of Primrose Unit as a nine bedded intermediate care unit for people aged over 65 years of age with dementia. The unit has undergone extensive refurbishment in preparation for this role, but it is disappointing to learn that this joint unit with the local Health Authority was not yet operational as the Health Authority are currently unable to identify the funds to provide a therapist for the unit. This remains the same at the time of this inspection. At present there are two vacancies. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 Service users care plans are comprehensive and clear, addressing individual’s health and care needs. However, risk assessments are not consistently updated following a change to a service user’s care need. Therefore service users can be assured that their care needs are monitored appropriately. Service users are confident that their medication is appropriately safeguarded and maintained by the home. EVIDENCE: Service user care plans are comprehensive and there is evidence of regular review and monthly updating as required under this standard. The plans include where appropriate evidence of consultation with service users or their families. There is an assessment of the risk of falls and how the risk is to be managed. The home has a comprehensive system to monitor falls, and is supported by the fortnightly visits of the NHS falls prevention manager in working proactively to reduce the number of falls in the home. Since the last inspector there has been twenty-eight recorded accidents, twenty-one of which relate to falls. A number of reports examined did not contain sufficient detail with regards to each incident. For example one service user’s report stated that the user was found in the lounge and no evidence was recorded of what treatment
BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 12 was given. The home has several lounge areas and therefore it was unclear as to the precise place the incident happened. It was also evident that risk assessments were not up-dated. The manager stated that since the last inspection two accidents have resulted in service users sustaining broken bones. Evidence of appropriate action taken by the home was recorded. The home currently has two service users who have pressure areas and five service users who are diagnosed with diabetes. A nurse sees the two service users who have pressure areas twice a week. The community team are also currently providing fortnightly visits and the five service users with diabetes are regularly monitored. It was advised that the service users diagnosed with diabetes should have on their file information with regards to their general care and advise on their daily diet such as what foods they should avoid. A copy of a leaflet was given to the manager regarding to diabetic and is the appropriate an diet. All residents are registered with a GP who runs a weekly surgery at the home. The GP visited during the inspection were very positive about the home, the staff and the care provided for the service users. Records of medicines received, administered and leaving the home are kept as required. Senior staff in the home only administer medication and they have all received appropriate training from the local pharmacist. It was observed that service users were treated with respect and spoken to appropriately by care staff on duty. Healthcare needs are recorded in the service users daily logs. It was recommended that medical history of each service user should be kept separate. This would give a clear medical history account of individual healthcare needs during the time the service user resides in the home. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 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 standard(s) 12, 13 & 15 Service users maintain family contact and participate in various planned activities in house and in the community weekly. The meals in the home, offers choices, variety and cater for special dietary needs. EVIDENCE: The home has an activity programme in place. Service users spoken to stated that the activities provided are enjoyable. The manager stated that one activity that has proven difficult is to obtain a hairdresser for home. At present the care staff complete this task. It was advised that the manager should advertise for a hairdresser. The inspector spoke to one of the service users relative. The feedback was very positive and the relative was pleased with the service they have received. Menus displayed in the kitchen showed a varied diet on offer, and that individual preferences are catered for, and one service user confirmed this. The menus are on a three-week rotation, and have been redrafted in consultation with service users. The meals are prepared in the large kitchen area and then transferred into trolleys for each unit. Meal provided on the day seemed nutritious, wholesome and balanced. The inspector sampled the lunch on day one, which was good. The only concern raised with the manager regarding the menu related to service users who are diabetic. It was not clear from the menu plan whether dietary needs of individuals with diabetic were being fully.
BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 14 This was discussed with the manager and a requirement has been made under ’Health and Personal care’ regarding this issue. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 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 standard(s) 16 & 18 The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to. Service users are protected with the knowledge that staff are well trained and understand the procedures with regards to abuse. EVIDENCE: A copy of the complaints procedure is included in the welcome pack provided to new service users. This document requires updating to state that the regulatory authority to which complaints can be made is now the Commission for Social Care Inspection. There have been no complaints made to the Commission for Social Care Inspection in respect of this home since the last inspection. During the inspection one of the service user complained to the inspector that their purse containing money was missing from their room. The complainant reiterated this to manager and one of the senior members of staff. The manager stated that the service users money was safe, however, the purse was missing. Several members of staff undertook a search of the home with regards the service user’s complaint. However, nothing was found on day one. It was observed by the inspector that the care staff handled the complaint made by the service user appropriately. On the second day of the inspection, the inspector was informed that the service user’s item was found. The complaint book was examined and it was evident that not all the information with regards the complaint was recorded. It was advised that this must be completed.
BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 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 standard(s) 19, 21 & 26 The home is appropriately decorated, therefore providing the service users with a warm and inviting pleasant environment they can call home. However, there are some maintenance areas that need addressing. EVIDENCE: The Broadwater Lodge is divided into smaller unit area, these are: - Hibiscus, Holly, Primrose, Rowan lower, Rowan ground and Main Rowan. Each unit has dining/kitchen/lounge areas, bath/shower & toilet rooms and single bedrooms. Hibiscus is a specialist unit supporting service users from an Afro Caribbean background. During the tour of the building it was evident that: • A number of bins did not have a lid on them, • The laundry room had the incorrect detergent dispenser in place for the washing machines installed, • Lobby platform areas outside of the kitchen had a number of containers of used cooking oil. • The large dust carts had no lids on them
BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 17 • • • A number of rooms’ doors were found to be wedged opened. One service users in bedroom 39 request that there bedroom door remains open at all times. This was discussed with the manager. Damp found on the kitchen store wall. Smoking room was being used as a store area. Bathroom and toilet areas are equipped with appropriate bath chairs and railings, and records examined showed that these items were subject to regular maintenance. A tour of the building revealed no areas of odour and a generally satisfactory level of cleanliness. At the previous inspection it was required that the laundry area be re-decorated, including repairs to wall tiles and re-flooring to provide a suitable impermeable finish. However, this still remains the same. The manager stated that this is part of the refurbishment programme. There are a number of maintenance areas regarding the main communal areas and fabric of the building. A meeting was convened outside of this inspection between The London Borough of Haringey and Commission on the 21st June 2005 to discuss the scheduled of works planned for Broadwater Lodge and other homes within the borough. The refurbishment programme for Broadwater Lodge is schedule for August 2005. This will continue to be monitored by the Commission to ensure the areas for improvement are addressed. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 A good skill mix of care staff supports the service users, therefore ensuring at all times suitably competent and experienced staff are working in the home. EVIDENCE: At the previous inspection there was a number of care staff that was employed by the agency. The manager informed that the vacancies for the home are now one kitchen assistant part-time, five carers, four domestics part-time, one activity person part-time and one laundry assistant part-time. The staff team consist of the manager, assistant mangers, domestic, carers, cooks and assistant cooks, administrator, handy person and laundry staff. On duty were the manager, nine care staff, the cook, one assistant cook, four domestic, the laundry assistant, three seniors, the administrator and the handyperson. The rota shown and indicated that the shifts are adequately managed. At the previous inspection it was required that the registered provider conducts a review of the staffing. The manager stated that the registered provider is still in the process of completing this. Staff records were not examined at this inspection. The inspector plans to examine these at the next inspection. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35, 36 & 38 The registered person runs the home in the best interest of the service users, therefore ensuring that service users are safeguarded by policies and procedures with regards to their care, their personal finance, support needs and health and safety. EVIDENCE: The registered manager is currently undertaking the care components at NVQ level 4, which will lead to the registered manager’s award. On the second day the manager was having a one to one session with her NVQ assessor. Discussion with staff suggested that they saw the registered manager as open and approachable. During the tour of the building, interaction with residents was warm, with the manager showing a detail of knowledge about each individual service user. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 20 The home has an administrator in place. The administrator explained the home’s procedures with regards managing service users personal monies. It was evident that individual monies and financial interests are safeguarded. Supervision records are in place. It was evident that all the Health and Safety checks required under Standard 38 were in place. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 3 x x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 x 3 3 x x 3 3 x 3 BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 22 Yes 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 16 Regulation 22 Requirement The registered person must ensure that a detailed record of the complaint made by a specific service user on the 20th June 2005 is kept on file. This is to include the investigation and any action taken. Evidence of this must be available for the purpose of inspection. The registered person must amended the homes Statement of Purpose to include a:· List of all room sizes. · Qualification of the registered provider and · Gender range of service users who reside in the home. Evidence of this must be available for the purpose of inspection. The registered person must ensure that if a service user has a fall or any change to their care needs, risk assessment/s must to be up-dated. Evidence of this must be available for the purpose of inspection. The registered person must ensure that all service users who are diagnosised with diabetes Timescale for action 30th August 2005 2. 1 6(a) 16th September 2005 3. 8 14(2)(a)( b) 16th September 2005 4. 8 12(1)(b) 30th August 2005
Page 23 BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 5. 19 & 26 23(2)(b) (c) 6. 19 13(4)(a) 7. 19 24(3) have in place on their care plan/s comprehensive risk assessment which addresses individuals dietary needs, care needs and support. Evidence of this is to remain on file. The registered person must ensure that:· All bins have lids. · The correct detergent containers are used for the washing machines installed, · All the oil containers in the lobby platform area outside of the kitchen are removed. The dust carts must all have the appropriate lids in place. · The damp area found on the walls in the kitchen stores addressed and the smoking room now being used as storage area now cease. The laundry room must be addressed the floor issue. The registered person must ensure that all fire doors are able to effectively self-close at all times and are not wedged open. The registered person must ensure that all the service users who reside in the home are aware of the potential risk of having their bedroom doors wedged open. The registered person must kept the Commission updated with all works programme plan for the home. 30th August 2005 30th August 2005 30th August 2005 8. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 24 BROADWATER LODGE 1. 2. 3. Standard 12 19 8 It is reccomended that the reigstered manager should advertised for a hairdresser. It is reccomended that the specific service user who requires their bedroom door to remain open at all times, magnetic door closure are to be installed for their safety. It is recommended by the inspector that the registered person should record all healthcare information for each individual service users separately in their care plans. BROADWATER LODGE G59 S10709 Broadwater Lodge V230595 20.06.05 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate, London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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