Inspection on 23/11/06 for Brownhills Nursing Home

This inspection was carried out on 23rd November 2006.

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

Brownhills Nursing Home 25/01/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Brownhills Nursing Home 29-31 Hednesford Rd Brownhills West Midlands WS8 7LS Lead Inspector Mrs Mandy Beck Key Unannounced Inspection 23rd November 2006 09:30 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 Brownhills Nursing Home DS0000064827.V316177.R02.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. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brownhills Nursing Home Address 29-31 Hednesford Rd Brownhills West Midlands WS8 7LS 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) 01543 374114 Kidderminster Care Ltd Dawn Lindsay Whitehouse Care Home 38 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (38), of places Physical disability (38), Physical disability over 65 years of age (38), Terminally ill (6), Terminally ill over 65 years of age (6) Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2006 Brief Description of the Service: Brownhills Nursing Home is located in a pleasant residential area on the outskirts of Brownhills, not far from Chase Water Country Park. The home is accessible by public transport. A shop and day club for the elderly are close by. The home is registered to provide nursing care to a maximum of 38 people. The external appearance is attractive but unusual. It was transformed some 15 years ago from a nightclub to its present form. It has good size car park at the front and a generous size, attractive garden to the rear. The home has a high proportion of double bedrooms, three of them have ensuite facilities. There are 10 single bedrooms within the home. There is a large lounge with a clearly defined dining area on the ground floor and a smaller lounge with dining area on the first floor. There are assisted bathing and toilet facilities throughout the home. The ground and first floor are accessed by passenger lift. The home currently charges between £432.25 and £485.00 per week for residency. there may be an additional “top up” charge in some cases. Theses fees do not include extras such as hairdressing, newspaper and chiropody services. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service conducted by one inspector from the Commission for Social Care Inspection (CSCI). Judgements made throughout this report are based upon information supplied to the CSCI by the home manager, by touring the building and talking with the staff and service users. Other time was spent reviewing service user files as part of the case tracking process and examining staff files to ensure the home has safe and robust recruitment practices. This was a very positive inspection and the inspector would like to thank the manager, all of the service users and staff for their hospitality throughout. What the service does well: The home provides prospective service users with good information about the home to enable them to make a choice about whether they wish to move into Brownhills Nursing Home. All prospective new service users are encouraged to visit the home, stay for the day or for a meal if they choose to do so. One service user commented, “Well informed we all had a good look round and spoke to the staff”, other service users who were unable to visit stated “my daughter came to look round we heard good reports about it” All of the service users at Brownhills Nursing Home can be assured that they will receive medical attention promptly and they can be confident that a knowledgeable and well trained workforce will meet their needs. Medication practices within the home protect service users wellbeing and are only administered by qualified nurses. Service users are encouraged to take part in activities in the home. Meal times are mostly a relaxing time for service users, all service users agreed that the chef is very helpful and willing to meet their needs. Comments included “meals are normally very good, a new menu is now in place and much improved”. The home has good systems in place for dealing with compliments, complaints and allegations of abuse. All service users can feel confident that should they have cause to complain their views will be acted upon and investigated thoroughly by the manager. Staff are recruited safely and all staff have the appropriate checks in place to safeguard service users, staff receive regular training and are well supported by their manager, “Dawn is very good, she will always try to help us”. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 7 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 Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that they will receive good information about the service the home provides. Their individual needs will be thoroughly assessed prior to admission so service users can feel confident that their needs will be met by an experienced and skilled staff team. EVIDENCE: The home produces a comprehensive Statement of Purpose and a Service user guide both are displayed in the reception area and are available on request. Both documents contain all of the required information to meet the National Minimum Standards. All of the service users who responded to the CSCI questionnaire indicated that they had received enough information about the home prior to their admission to enable them to make a choice about living there. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 9 The manager will visit all prospective service users before their admission to assess their needs and talk through their expectations. Service users can feel sure that their needs will be individually assessed and will be transferred into an individual care plan that details how these needs will be met. All new service users are encouraged to spend time at the home before they make a choice about living there. Some service users indicated that they were unable to “try out” the home because of their circumstances and had left the choice of home to a relative. “I am very pleased with the home that I am in”, “my daughter came to look she had had good reports about it”, “it’s a good choice”. Service users are issued with a contract and terms and conditions of residency upon their arrival, the contracts need to be reviewed to ensure that they clearly detail the fees that service users will be paying, this should include the nursing contribution and the top up fee where applicable. Staff at the home are experienced and skilled, there is a mix of trained nurses, care workers and adaptation nurses. Recently all of the staff have undertaken training in Dementia Care, Care of the Dying and Bereaved and Palliative care. This training compliments the skills and existing knowledge of the staff group and service users should feel confident that their needs will be met by competent staff. One service user commented “I would be lost without them”. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 10 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users can be assured that their needs will be met at all times. Medication practices safeguard service users and they can feel confident they will receive their medication as it is prescribed for them. Service users will be treated with respect and dignity at all times EVIDENCE: Service user files were seen as part of the case tracking process; all of the files contained a service users plan that contained comprehensive details of actions that need to be taken to meet service users needs. There are risk assessments in place that address the possibilities of pressure sore development, falls, malnutrition and moving and handling to the service user. It was pleasing to see that where risks had been identified the staff had produced a plan to reduce or minimise the risk to the service user. For Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 11 example one service user had been identified as being at risk of developing pressure sores, the plan had included a number of actions for staff to take to reduce the risk with the provision of appropriate pressure relieving equipment, regular position changes and seeking the advice of the tissue viability nurse, as a result of this planning the service user does not have pressure sores. All of the care plans seen were regularly reviewed and updated according to the changes of service users individual needs. Staff are to be congratulated on the hard work they have done in completing all of the documentation for service users because since the last inspection a new system of record keeping has been introduced. All service users have access to specialist medical, nursing, dental and other therapeutic services both in hospital and community according to their needs. There is evidence that service users were accessing the specialist skills of the Dietician, Speech and Language Therapists and the Community Mental Health Team. Medication practices within the home are robust. There are very good systems in place for the recording of all medicines received, administered and leaving the home. This means that the risk of mishandling is greatly reduced. Medicines are stored safely in a locked trolley. Controlled medicines are stored as recommended and there are good recording and checking systems in place that again reduce the risk of error. There are policies and procedures within the home for the guidance of staff and only trained nurses administer medication under guidance from the Nursing and Midwifery Council (NMC). The policy needs to be updated to include the practice of covert administration. The home completes its own medication audits on a monthly basis and the providing pharmacist completes an external audit on a six monthly basis, this ensures that the home is practising to the best of its ability regarding medicines at all times. Service users can be assured that they will be treated with respect and dignity at all times. Staff speak to service users in their preferred term of address, staff were seen to be knocking doors to service users rooms before they entered and were engaging service users in positive conversation throughout the day. For example, one service user was upset and anxious, care staff took time to sit and talk to the service user reassuring them and giving them some comfort. In other instances a service user who required the hoist to enable them to move were helped to do so in a manner that ensured their dignity was maintained throughout the manoeuvre. Comments from service users “the care is very good, couldn’t be looked after any better”, “I’m happy and content with the staff who look after me 100 ”. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the home will encourage them to maintain their social contacts, make choices about their lives and will be able to take part in activities. Meals are provided in sufficient quantity for service users needs. EVIDENCE: All service users have a social activity care plan within their individual file, these plans detail their individual preferences regarding activity and are recorded by care staff. The manager has plans to introduce “life history” books in the near future, this can be used as a reminiscence activity for some of the service users and form the basis of person centred care planning. Service users commented that they “would be lost without the girls help”, “they put on entertainment for us, I like the singers”. More recently staff and service users have decorated the home for Halloween and have taken part in Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 13 raising money for Children in Need by dressing up in fancy dress. There are plans in progress to begin decorating the home for Christmas, service users are busy making decorations with staff. Relatives were also pleased with the service that the home provides commenting “the care is very good, couldn’t be looked after any better,” “we are more than happy with the staff”, “there has been a vast improvement in mom since she arrived at the home”. Most of the service users who answered the CSCI questionnaire stated that they were happy with the meal provision at the home. The home provides four meals a day and these are cooked on the premises by dedicated kitchen staff. The inspector observed lunchtime, service users were relaxed and those service users who required assistance where helped discreetly. Service users were not rushed into finishing their meals and two choices were available for them. A few of the service users stated that they didn’t like the gravy on their meals, this was discussed with the manager at the time of the inspection, it was suggested that perhaps the gravy could be served once the service user has their meal so that they can make the choice about having it on their meals. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user can feel confident that their complaints will be listened to and acted upon. There are good policy and procedures in place to safeguard service users from abuse. EVIDENCE: Since the last inspection the home has developed its complaints policy and reissued it to all of their service users. The policy is now much more detailed and clearly shows service users how their complaints will be investigated. The manager must give consideration to making this policy available in other formats such as different languages, audio or DVD version to ensure that all service users can access it. There have been no complaints or concerns received in the past twelve months. One service user said “if they don’t listen to me I tell them off, If I needed to complain I would talk to the manager” others said “always a care assistant available I trust to discuss problems”. “we do know how to complain but have never had any reason to”. All of the staff at Brownhills nursing home have now completed their vulnerable adult training, this means that staff are now equipped with the skills Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 15 and knowledge to spot potential signs of abuse and deal with allegations when they arise. There are policies within the home that protect service users and staff alike. All staff files seen contained relevant checks regarding Protection of Vulnerable Adults (PoVA) and Criminal Records Bureau (CRB) disclosures. Brownhills Nursing Home DS0000064827.V316177.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a well maintained and clean environment. EVIDENCE: The home continues to maintain the environment and the redecoration. A partial tour of the building was undertaken and it was pleasing to see that toilets and bathrooms had liquid soap and paper towels, this will help to minimise the spread of infection. The home was clean and bright and odour free. The laundry is situated on the ground floor and there are dedicated laundry staff to ensure that service users clothing is cleaned. It was observed that some detergents and cleaning materials were not being stored in a locked Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 17 cupboard and that disinfectant had been decanted into a plastic bottle, this must not happen, products must be kept in their original bottles with their data sheet informing staff of the hazards. There is currently no cleaning schedule for the laundry although it is clear that staff are very sure of their roles and do keep the laundry clean and free from dust, reducing the risk of spreading infection. Brownhills Nursing Home DS0000064827.V316177.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users can be assured that they will be cared for by staff who are experienced and skilled. Staff are recruited safely and there are good systems in place to protect service users. Staff receive regular supervision and appraisal to ensure that they are competent to do their jobs. EVIDENCE: The home is staffed with the following: 1 trained nurse and 6 care staff morning shift 1 trained nurse and 5 care staff afternoon shift 1 trained nurse and 3 care staff night shift The Home Manager is not included in care numbers. The home also employs staff for kitchen, laundry, housekeeping and maintenance. The home has more than the required 50 of care staff with NVQ level 2 or above, this demonstrates the commitment of the home in providing good quality care by well trained staff. Staff are supported to undertake external Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 19 courses to develop not only their own practice but also the practice of other staff to assist in the delivery in high standards of care. The home also supports student nurses and adaptation nurses through their training by offering them placement and mentorship during this time. Recruitment and selection procedures within the home are robust and safeguard service users. All required checks were in place such as PoVA and CRB disclosures. All new workers are supported through the induction programme that meets the Skills for Care Standards, and existing staff are supported by the manager through supervision and annual appraisals. Staff have good training opportunities and have a training and development plan developed as part of their appraisal. All staff have at least three training days each year. Brownhills Nursing Home DS0000064827.V316177.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the home is run in their best interests. The manager is experienced and competent and service users are confident that she will act in their best interests. EVIDENCE: The manager of the home is Mrs Dawn Whitehouse, she is both qualified and experienced and has managed the home for many years. Service users have confidence in her and have said “if I need anything I tell matron, she always listens and helps”. Recently Mrs Whitehouse has undertaken further training in dementia care and palliative care to keep her skills updated. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 21 The quality assurance system within the home has begun to evolve and it was pleasing to see that the results of recent service user and multi disciplinary surveys had been published and were available in the service user guide. Both of the surveys were very positive and encouraging. The manager continues to audit care plans, medication and the environment on a monthly basis to ensure that standards are being maintained. The home no longer deals with any personal monies of the service users. The administrator deals with all fees for residency. Regular and required checks are undertaken on the fire alarm, emergency lighting, fire extinguishers, nurse call points and hot water. It was noted that a couple of bedrooms failed to reach to required hot water temperature recently this was bought to the managers attention during the inspection, who will take steps to rectify this. Records identify that staff regularly attend mandatory training in fire safety, moving and handling, food hygiene, first aid, health and safety, infection control and the protection of vulnerable adults. Maintenance records and contracts were reviewed and were found to be up to date. Brownhills Nursing Home DS0000064827.V316177.R02.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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 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 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5A (5)(b) Requirement Timescale for action 01/02/07 2 OP9 13(2) 3 OP26 13(3) Service user contracts must be reviewed using following guidance from the Office of Fair Trading publication 2003 The registered manager must 01/02/07 update the medicine policy to include to the administration of covert medication. The registered manager must 01/02/07 formulate a cleaning schedule for the laundry COSHH materials must be stored securely and must not be decanted into unlabelled bottles. Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP1 OP16 OP18 OP26 Good Practice Recommendations It is recommended that the service user guide and statement of purpose are produced in other formats It is recommended that the complaints policy be produced in different formats. It is recommended that the manager obtains a copy of new guidance for the Protection of Vulnerable Adults from Walsall MBC It is recommended that the manager obtain a copy of the Department of Health guidance on infection control (June 2006) Brownhills Nursing Home DS0000064827.V316177.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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