CARE HOMES FOR OLDER PEOPLE
Brooklands Residential Home 16 Harper Lane Yeadon Leeds West Yorkshire LS19 7RR Lead Inspector
Sue Dunn Key Unannounced Inspection 11:15 16th May 2007 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 Brooklands Residential Home DS0000001429.V335760.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. Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brooklands Residential Home Address 16 Harper Lane Yeadon Leeds West Yorkshire LS19 7RR 0113 2508677 P/F 0113 2508677 mandyjowett@hotmail.co.uk 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) Mr Paul C Jowett Mrs Amanda Jowett Mrs Amanda Jowett Care Home 27 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (27) of places Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The place for DE is specifically for the service user named in the variation application dated 20.9.4 One specific service user under the age of 65, named on variation dated 1st February 2007, may reside at the home. 4th July 2006 Date of last inspection Brief Description of the Service: Brooklands Residential Home is situated near Yeadon town centre, which is a suburb of Leeds. The home is situated within easy reach of local amenities, including the local supermarket, and is on a bus route. There is an area at the rear of the building for off road parking. The building is an extended and converted detached property. There is a pleasant conservatory on the side of the building, which opens out into a secure and pleasant garden area. Accommodation for service users is provided in nineteen single rooms and four shared rooms. The ground floor has two lounge areas and a dining room in addition to the conservatory. The home provides residential care for up to twenty-seven older people of both sexes. The current fee per week is £400. This does not include hairdressing, chiropody, personal clothing and toiletries or newspapers. Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcomes for service users. The inspection report is divided into separate sections with judgements made for each outcome group. The judgements reflect how well the service delivers outcomes to the people using the service. The categories are “excellent”, “good”, “adequate” and “poor”. More detailed information about these changes is available on our website – www.csci.org.uk. The manager completed a pre-inspection questionnaire and this information with information supplied since the last inspection was used as part of the inspection process. One inspector carried out the inspection visit arriving at 11:15 am without prior arrangement and leaving at 5:00 pm. During the visit, service users, staff, visitors and manager and matron were spoken with and observed, the care records of three people were examined closely, staff records and other documentation was examined, there was a tour of the building and care practices were observed. What the service does well:
Each person moving into the home receives an information pack which includes details of the home’s facilities and services, the terms and conditions of occupancy and a copy of the complaints procedure. The assessment process is thorough and includes a visit to the home to ensure peoples’ needs can be met within the environment. Care plans were easy to follow with a summary, acting as an index to more detailed care plans. The daily notes related to the plan of care and there was evidence to show that care plans were reviewed and some amendments made as needs changed. One relative felt that the family had ‘made the right decision’ in their choice of home as the manager ‘seems to understand more than most my mother’s condition and know how to care for her’. A person being cared for in bed was clean and comfortable with every attention given to nutritional intake and pressure area care. People living in the home made comments such as ‘the staff are marvellous’ ‘nothing is ever too much trouble’. Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 6 People had forged friendships with the people they sat close to. One person said ‘we are good pals, never had a bad word. I am glad I was seated next to her when I first came.’ People in the home described the food as ‘excellent’ and it was apparent that people could choose to eat in their rooms. The home is well decorated, clean and free from any odours. The building has a comfortable homely feel about it. Personal laundry and bedding were laundered to a good standard. What has improved since the last inspection? What they could do better:
Some care plans could be improved by giving more detail to show how care was to be given rather than simply saying what was to be done. If any equipment is used which may lead to a restriction of freedom of movement for anyone living in the home this must be clearly stated in the care plan with the reasons why such action has been taken. There should be evidence to show that any plan of care intended to encourage mobility or independence has been discussed and agreed with the person concerned and /or their family. The information about individual backgrounds and interests could be used to direct activities towards specific interests. The daily menu should make it clear that people can choose alternative options for every meal. One person said ‘We have sandwiches every day, I am sick of them so I am having toast.’ It was not clear that more recent occupants were aware they had choices. The managers should look at alternative ways in which people who are reluctant to approach them can bring any matters of concern to their attention. The cluttered laundry area must be cleared to make it easy to keep clean and reduce the risk of cross infection. Notes should be kept of the interview process for the protection of the persons conducting the interview and the applicants. Systems must be in place to ensure health and safety checks are not overlooked.
Brooklands Residential Home DS0000001429.V335760.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. Brooklands Residential Home DS0000001429.V335760.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 Brooklands Residential Home DS0000001429.V335760.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): 1, 2, 3, 4, 5 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Information about the home and a pre visit gives prospective service users the opportunity to decide if the home can meet their needs. The assessment procedure is thorough and people can be sure that the home will not offer to provide a service unless the staff are able to meet their needs. EVIDENCE: One person had moved in to the home just before the inspection visit. The admission had been preceded by a full day visit to see if the home was suitable. There was a good background history to help staff get to know the person and assist in his care. Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 10 The pre admission assessment for another recently admitted person included an initial enquiry form completed when relatives had visited. It was clear that the assessment took place whilst the person was in hospital and that a visit to the home had been arranged to assess the person’s ability to use the stairs. An assessment of needs carried out by a hospital social worker was thorough. A contract had been signed but the original had not yet been returned. A contract for another person was signed. Each person moving into the home receives an information pack which includes details of the home’s facilities and services, the terms and conditions of occupancy and a copy of the complaints procedure. Brooklands Residential Home DS0000001429.V335760.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, 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The care records gave a good overview of the care being given but would benefit from more detail (in the guidance as had been recorded in daily progress notes) to make sure that care needs of the people at the home are not overlooked. People are protected by safe systems for the storage and administration of medication. EVIDENCE: Care plans were easy to follow. There was a care plan summary for each area of care and if any support was required staff were directed to a numbered, more detailed care plan which was reviewed monthly. Review notes were
Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 12 recorded on the back of the care plan and were detailed. The daily progress notes made reference to the care plans, as did the monthly reviews. One care plan gave guidance on personal care and keeping in touch with a relative. The manager was able to explain how this was done but it was not noted in the care plan. Another care plan included a risk assessment as the person was restless at night. Staff were initially instructed to be vigilant, with a later addition to the care plan showing that a pressure pad had been installed to alert staff when the person was out of bed during the night. The same person was sitting in recliner chair in the lounge with the call alarm close to hand. This meant that the person was restricted and could only stand up with the assistance of staff. The chair was said to be used to make the person more comfortable on days when her mobility was poor. This should have been made clear in the care plan to ensure it was not used as a form of restraint. A relative felt the family had made the ‘right decision’ in their choice of home and said ‘Mandy (the manager) seems to understand more than most my mother’s condition and know how to care for her. We can always discuss anything before it becomes an issue’ The relative knew about care plans and said there were regular meetings with the family to discuss the care. One person was cared for in bed. The general background information showed her interests but she was now too frail to follow these. The care plan guidance showed she was on 2 hourly turning, had a pressurerelieving mattress, mouth care and fluid input and output records and was on food supplements. She was very well cared for in bed, the room was of a comfortable temperature and the TV was playing quietly in the background. The monitoring records were completed and up to date. Seven people were spoken with and made comments such as ‘the staff are marvellous’ ‘nothing is ever too much trouble’. The home has recently purchased a sit on weighing scale and has started to weigh everyone. Follow up weighing will then be based on individual needs for monitoring. A senior member of staff described the medication system. The pharmacy, which has recently been changed for proximity and convenience, still provides a pre-dispensed system. The person spoken with is responsible for the safe recording and return of unwanted medication and was able to explain the methods of storage and recording of controlled medication. The medication records have a photograph of each person for identification. Brooklands Residential Home DS0000001429.V335760.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): 12,13,14,15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home identifies peoples’ interests as part of the assessment process and it was evident that some social and recreational activities take place. However, there was little evidence to show that care staff support people’s social and recreational needs on a day-to-day basis. The meals meet the nutritional needs of people living in the home. EVIDENCE: Most of the people sitting in the lounge were sleeping during the morning and the atmosphere was generally subdued. The matron felt that staff and people living in the home had been affected by the recent deaths of two people within a few days of each other. Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 14 The pre inspection questionnaire completed by the manager stated that there were clothes parties, bingo, quizzes, and that a motivation group and entertainers visited regularly. Outings took place, both planned and to church, local shops, post office and pubs. One person said there was entertainment occasionally, particularly at Christmas, and another said she went out to the bank when a member of staff was available to go with her. There was no organised activity on the day of the visit and little interaction seen between staff and the people living in the home to indicate social and recreational activity was part of their role. Some people were seen with newspapers, knitting, reading and puzzle books. The care files seen did give some information about peoples’ interests but there was nothing in the care plan to indicate activities were directed towards specific interests. It is recommended that social or recreational events in each person’s day be recorded. It was clear that some people had forged friendships with the people they sat close to. One person said ‘we are good pals, never had a bad word. I am glad I was seated next to her’ One person said she hated not doing anything but said her family were very good in giving their support. There were a number of visitors during the course of the day. The menu was nutritional and varied but did not indicate that people can have an alternative option at mealtimes. The cook said that everyone liked the gammon so they were all having the same on the day of the visit. Another said the ‘food is excellent, we have a nice little breakfast, everyone comes to the table to have it’. However it was apparent that people were able to eat in their room as one person was having tea in her room. Another person said of teatime ‘ there is sometimes scrambled egg on toast or something like that. We have sandwiches every day, I am sick of them so I am having toast’ Brooklands Residential Home DS0000001429.V335760.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, 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People are protected by the home’s complaints procedure but it appears not all people feel confident to use the procedures and speak to the managers. Staff have had training on the Protection of Vulnerable Adults to make sure that the people at the home are protected from abuse. EVIDENCE: One anonymous complaint since the last inspection alleged people visiting the home parked on the road outside rather than in the home’s car park. The manager said relatives or ambulances occasionally parked at the gate whilst returning people to the home to reduce the distance they had to walk to the front door, as was experienced on the day of the visit. She stated that visitors were otherwise asked to use the car park. Another person alleged that a member of staff was overheard using the name of the manager as a threat to get people living in the home to cooperate. The manager had not been aware of this but said that an employee who was found to use inappropriate language no longer worked in the home. Any programme to encourage mobility and independence must be explained and agreed with the person concerned and/ or their family and be recorded as part of the plan of care.
Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 16 The manager and matron felt they were approachable and had an open attitude to complaints. They were concerned that the complainants had not felt able to use the home’s complaints procedure to discuss their concerns. Staff had received adult protection training. Brooklands Residential Home DS0000001429.V335760.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, 20, 22, 23, 24, 25, 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home provides a safe, well-maintained and comfortable environment for the people that live there. The standard of laundering was high but clutter in the laundry could lead to risks of cross infection. EVIDENCE: Some of the people who lived in the home pointed out the new carpets, which had been fitted throughout the ground floor area and some of the bedrooms. They had only been fitted the previous day and one of the doors required adjusting to make sure it closed freely.
Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 18 All areas of the home, which were seen, were clean, homely and free from unpleasant odours. People had been able to bring chosen possessions into their rooms to make them familiar and homely. Décor and soft furnishings throughout were of a good standard. A mobile hoist, new wheelchair and a sit on weighing scale had been provided since the last inspection. Pressure relieving equipment and a pressure pad to alert staff if someone was out of bed at night were also in use. Personal clothing and bedding was laundered to a good standard. The laundry area was rather cluttered making it difficult to keep clean and raising the risk of cross infection. Brooklands Residential Home DS0000001429.V335760.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): 27,28,29,30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People who use the service are protected by the rolling programme of training including NVQ, which gives staff the knowledge and skills to meet their needs. EVIDENCE: One staff file was examined and two staff were spoken with. The file showed an application form had been completed, a Protection of Vulnerable Adults and Criminal Records Bureau check had been carried out and two written references had been received. There were however no notes of the interview to show the thoroughness of the selection process and to show evidence that more than one person had carried out the interview in accordance with equal opportunity for applicants. A member of staff explained that when she was first employed she had not been left to work alone and she had worked through the subjects in the induction-training booklet. This covered Health and safety, fire, moving and handling, She was shown how to use the hoist and how to use slide belts for moving people. She was now working towards the National Vocational Qualification (NVQ) award.
Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 20 A senior care worker said she had completed NVQ 2 and 3 and had completed the distanced learning medication training. She said staff had just had a fire safety training update. The induction training is followed by a rolling programme of training for all staff. Staff had received training on the use of the hoist and adult protection since the last inspection. Brooklands Residential Home DS0000001429.V335760.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): 31, 33, 36, 37, 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is managed in the interests of people who use the service. EVIDENCE: The proprietor/manager has achieved her NVQ 4 management certificate and has many years of experience working with the terminally ill and older people. She works ‘hands on’ and is supported by a matron manager who has worked
Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 22 in the home for many years and whose main responsibility is for staff training and administrative duties and a deputy manager. The manager said she had started auditing different aspects of the home and had recently completed a risk assessment for fire safety, which had been approved by the fire safety officer. One care worker spoke of the appraisal system. She said appraisal/supervision is usually done with the assistant manager, notes are taken and each signs to agree the information is correct. A copy of the appraisal/supervision form was seen. This covered areas of work performance and training needs. The person responsible for the weekly fire point checks was on maternity leave and there had been some gaps when this had not been done. The assistant manager said this task had now been put in the diary and the checks were now being recorded weekly. Fire fighting equipment was checked in January 2007 Records showed that regular water temperature checks had been done Hoists and stair lifts had been checked. The Landlords Gas Safety Certificate last done in January 2006 was overdue but had been arranged. Brooklands Residential Home DS0000001429.V335760.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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 3 3 3 2 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 4 x 3 x x 3 3 2 Brooklands Residential Home DS0000001429.V335760.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 Refer to Standard OP7 Good Practice Recommendations The care plans must provide staff with detailed information on how to meet individual residents needs. Any restriction of freedom of movement for anyone living in the home must be clearly stated in the care plan giving reasons why such action has been taken. Any plan of care intended to encourage mobility or independence must be discussed and agreed with the person concerned and /or their family. 2 3 4 OP12 OP12 OP16 Information about individual backgrounds and interests could be used to direct activities towards specific interests. The daily menu should make it clear that people can choose alternative options for every meal The managers should look at alternative ways in which
DS0000001429.V335760.R01.S.doc Version 5.2 Page 25 Brooklands Residential Home people who are reluctant to approach them can bring any matters of concern to their attention. 5 6 OP26 OP29 The cluttered laundry area must be cleared to make it easy to keep clean and reduce the risk of cross infection. Notes should be kept of the interview process for the protection of the persons conducting the interview and the applicants. The quality assurance system is in its early stages and should be followed by a report, which can be made available to people who, use the service, the CSCI and any other interested parties. Systems must be in place to ensure health and safety checks are not overlooked. 7 OP33 8 OP38 Brooklands Residential Home DS0000001429.V335760.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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
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