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Inspection on 19/10/06 for Carwood Residential Home

Also see our care home review for Carwood Residential Home for more information

This inspection was carried out on 19th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

Service users are supported by an effective staff team who receive good support and training opportunities. Staff have developed skills in order to safely support service users and their input prior to and during one service users hospitalisation is to be commended. Person centred care plans contain detailed information relating to individualised care and support needs and are constantly being reviewed and updated. Relatives commented on the excellent support service users receive when they are ill or in need of hospital support. Service users have opportunities to access community resources and maintain family links. The home has just been presented with the Corporate Health and safety award for achievements in improving health and safety standards within the home. The team are justly proud of this achievement.Staff feedback via comment cards suggested that the home `does well` at supporting new staff and having effective policies and procedures. The care, support and understanding of service users were described as `excellent`. The manager continues to work well in partnership with managers from other services in developing policies and procedures, induction, training, quality assurance.

What has improved since the last inspection?

Since the time of the last inspection of the home a service users who was experiencing issues in relation to his behaviour has moved out and this has had a positive impact on staff and service users. Staff feedback via comment cards suggested that improvements have been made in relation to the staffing situation within the home and communication, including more regular team meetings.

What the care home could do better:

The homes quality assurance process has identified that there is not sufficient communal space for service users to meet with family and friends or hold meetings. It is not always appropriate that service users have visitors in their bedrooms. The home is currently looking at options to address this issue. The flooring in one unit is badly stained and requires constant cleaning. Consideration should be given to replacing it with a more suitable and material. Feedback for staff comment cards reflected the above findings and also suggested that compatibility issues between identified service users are problematic. The home demonstrated that they are actively looking to resolve compatibility issues where they exist.

CARE HOME ADULTS 18-65 Carwood Residential Home 16 Carwood Stirchley TELFORD Shropshire TF3 1YA Lead Inspector Sue Woods Key Unannounced Inspection 19th October 2006 10:00 Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 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 Carwood Residential Home DS0000059615.V292570.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 Adults 18-65. 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. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carwood Residential Home Address 16 Carwood Stirchley TELFORD Shropshire TF3 1YA 01952 592436 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) Telford & Wrekin Council Paul Andrew Shirley Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: 16 Carwood is registered with the Commission for Social Care Inspection to provide accommodation and personal care to a maximum of 13 adults with a learning disability aged between 18-65 years. The home is situated in Stirchley, Telford and is owned and managed by the Borough of Telford and Wrekin Council. Mr Paul Shirley is the Registered Manager and Mr Paul Taylor is Head of Adult Services and is the Responsible Individual. Both the Manager and Responsible Individual are well qualified in the field of learning disability and have numerous years experience working for the local authority. Carwood was extensively refurbished to create five flats across two floors with a passenger lift and reopened in 2004. Accommodation in each flat comprises single bedrooms with en-suite facilities, a kitchen/dining area, a lounge, laundry room and a bathroom. The home offers access to local amenities, transport and relevant support services. The Mission Statement is To provide support to people learning disability, based on individual needs as identified through Community Care Assessments and Person Centred Plans. We aim to meet individual needs wherever possible. We aim to promote and increase individual service users independence, opportunities, choice, dignity, rights and quality of life. Create a home, which is safe, comfortable and personal to individuals. Therefore enabling service users to live and participate within their community. Information is shared with service users in the service user guide and in regular in-house meetings. Quality review questionnaires are sent out to service users families and supporters. Fees range from £787.82 to £943.00 a week although identified support packages may be charged at a higher rate depending on need. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Carwood took place on 19th October between 9.45 am and 3.00 pm, with a further visit to meet with service users and relatives on 7th November at 4.00 pm. The inspection reviewed all 22 key standards and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the fieldwork activity inspectors spoke with service users, relatives and staff and reviewed records including care plans (two in detail), rotas and health and safety information. Staff files were reviewed on 12th July 2006 when the inspector reviewed files retained at Telford and Wrekin Councils main offices. Comment cards were left for staff to complete and return to the inspector on her second visit. Eight were completed and returned. What the service does well: Service users are supported by an effective staff team who receive good support and training opportunities. Staff have developed skills in order to safely support service users and their input prior to and during one service users hospitalisation is to be commended. Person centred care plans contain detailed information relating to individualised care and support needs and are constantly being reviewed and updated. Relatives commented on the excellent support service users receive when they are ill or in need of hospital support. Service users have opportunities to access community resources and maintain family links. The home has just been presented with the Corporate Health and safety award for achievements in improving health and safety standards within the home. The team are justly proud of this achievement. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 6 Staff feedback via comment cards suggested that the home ‘does well’ at supporting new staff and having effective policies and procedures. The care, support and understanding of service users were described as ‘excellent’. The manager continues to work well in partnership with managers from other services in developing policies and procedures, induction, training, quality assurance. 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. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 7 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. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An effective admissions procedure is in place to ensure that the home will be able to meet the assessed needs of service users admitted. EVIDENCE: The inspector reviewed the file of a service user who is currently in the process of moving into the home. The manager reported that the home has already received detailed information. The assessment information seen contained a very detailed assessment and a health action plan. It was noted that adaptations are being made to the environment prior to her admission. The manager has made a complaint in relation to an inappropriate emergency admission to ensure such a situation does not arise again. The service user contract seen for one service user was user friendly and made good use of pictures. The contract makes it clear what the service user must pay for and what is included in the fees. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Person centred care and support plans enable staff to offer service users choice and assist with decision making as well as delivering care in a way that they prefer. Risk assessments ensure that support is given in a safe manner. EVIDENCE: Care plans were seen to be very detailed and provided essential information to staff in relation to delivering support consistently. Pictures supported manual handling techniques. Assessments were seen on files reviewed and there was evidence that reviews take place. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 11 Reactive management strategies were in place to support the behaviours of one service user and staff are required to sign and date to say they are competent to use the protocol. Restrictions were well detailed in both care plans reviewed. The religious beliefs were recorded for one service user case tracked and the deputy manager detailed how the home works closely with the family to support his beliefs, especially when he attends events with his family. The service user enjoys his ‘bangri music’. Communication profiles were seen on both files reviewed, as were numerous activity risk assessments. At the time of the inspection the member of staff supporting one of the service users case tracked was seen and heard to be offering choices about how the service user wanted to spend his day and she also asked him if he would be happy to talk with the inspector. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lead full and active lives with opportunities to participate in risk assessed activities of their choice. Service users benefit from supported family contact and involvement EVIDENCE: Menus seen reflected healthy eating and choice. Records were kept of foods eaten. Each ‘unit’ has it’s own menu and service users go shopping for their own groceries. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 13 One service user is supported by staff to attend religious festivals and events with his family. The majority of service users living at Carwood attend structured day services and in the evenings prefer to relax at home however some service users attend local clubs on a regular basis. On the evening of the first inspection visit service users were going to see Walsall Lights. Activities at weekends are varied depending on individual choices. Some service users go shopping, others visit family and friends. One service user enjoys local walks and a group of service users are being supported to attend shows. Service users recently went on a day trip to Barmouth. Family links are encouraged and supported. On the evening of the second inspection visit one service user was being visited by her family. They told the inspector that they felt that Carwood offered an excellent service and that they were always made welcome and were involved in decisions relating to their daughter. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from a knowledgeable staff team who support them in ways that they prefer and from good input from appropriate health care professionals. Service users receive ‘excellent’ support during times of ill health. Service users are protected by effective systems for the storage and recording of medication EVIDENCE: As well as detailed care and support plans service users are supported by health care professionals who work closely with staff at the home. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 15 Health care appointments are recorded in care plans and service users receive support to access them. Chiropody, dental and optician checks take place regularly and it is recorded when service users choose not to follow advise given. Following a period of ill health and then hospitalisation of one service user a member of his family wrote to the home and copied the letter to CSCI to say how happy she was with the support her son received during that difficult time. Discussions with the family of a second service user reflected the above comments. Medication arrangements were reviewed as part of the inspection. Two cabinets were reviewed at random. Both contained medication in a monitored dosage system. Records were well organised and there were no recording gaps in MAR sheets reviewed. Two signatures were seen when staff were being observed. The medication procedures and guidelines had been updated in January this year. Good records are kept. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by an effective complaints procedure and the home operates an open and accountable system of supporting service users to manage their money. EVIDENCE: Three complaints has been received by the home and recorded in the ‘Blue Book’. One was from a health care professional in relation to the implementation of a support plan. The complaint was resolved informally at a multi agency meeting. Additional training was implemented as a result. The other two were from a service user in relation to issues with another service user. There was evidence that the home had worked with the service users to improve relations between them. The complaints had been upheld. The manager reported that a copy of the complaints procedure has been sent out with contact details of the CSCI inspector. No referrals have been made to the adult protection team although the manager and staff have done the training to support such a referral. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 17 Details of a restraint on a service user were recorded in the appropriate care plan and appropriate training and support is available for staff who carry out such procedures. The deputy manager showed the inspector her monitoring systems in relation to managing service users moneys. Records seen had been well maintained and were being stored securely. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well-maintained providing service users with a safe place to live. However the environment could be further improved by identified areas having a floor covering that is more suited to its purpose. EVIDENCE: The inspector was given a tour of all areas of the home. Units were clean and homely. One service user showed the inspector his bedroom. The room was bright spacious and had been personalised. Other rooms seen reflected this standard. Equipment used in bedrooms is regularly maintained and serviced. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 19 The carpet in the hallway and the entrance to the lounge of unity 16C was seen to be badly stained. Despite staff’s best efforts to clean it, it remains unsightly and musty smelling. It is recommended that a suitable cleanable surface be found given that drinks are regularly spilt in that area. Bathrooms were clean although when the inspector tested the water temperatures they were found to exceed the safe regulated limit. The manager detailed problems with the regulators and immediately called out the contractor. He then increased the in-house temperature monitoring procedure. This procedure was seen in full operation at the time of the return visit to the home. Emergency lighting and fire safety equipment was being tested by engineers at the time of the inspection. The manager has identified areas of the home requiring maintenance and redecoration. He is currently negotiating a budget to carry out this work and this will be reviewed at the time of the next inspection. The latest quality assurance programme has identified that there is a lack of private space for people to meet with visitors or have meetings without restricting communal areas or using bedrooms. The management are constantly reviewing security arrangements to the outside of the home. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by well-trained and competent staff. Service users are protected by satisfactory recruitment and selection procedures. EVIDENCE: Staff who spoke with the inspector were very positive about the home and of their job roles. Staff felt well supported. One staff member felt ‘safe’ working at the home as she is supported by effective policies and procedures and care plans that reflect the needs of service users. Written feedback and records seen reflected these comments. The manager reported that although the home is fully staffed there has been a high level of staff sickness and agency staff have been used. There was Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 21 evidence to demonstrate that the home manger is monitoring sickness in line with the Councils policies and procedures Staff recruitment files were reviewed in July 2006. These files are consistently well maintained in line with Telford and Wrekin’s recruitment and selection policy. The manager was knowledgeable about the content of the files. It was stated by the manger that all staff now have an NVQ qualification or are in the process of working towards one. Attendance at staff meetings is required at least six times a year. This requirement is linked to the staff member’s person specification of employment. The manager demonstrated how he monitors that all staff attend all mandatory training courses and refreshers when due. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by an effective management team. The health and safety and welfare of service users and support staff is promoted and protected to a high standard. EVIDENCE: The manager of Carwood is knowledgeable about the service and the individual needs of service users. He receives regular support and training. The staff Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 23 team spoke very highly of the manager and there is a good team spirit within the home. Health and safety checks in relation to emergency procedures and fire safety checks are all carried out as appropriate. The manager stated that he is in the process of requesting that certificates for identified safety checks are kept on site. The home has just been presented with the Corporate Health and safety award for achievements in improving health and safety standards within the home. The team are justly proud of this achievement. Visits carried out by a representative of the Council in line with regulation 26 requirements reflect the findings of this inspection report. The visitor speaks with staff and service users as part of the process. Service users are consulted in decision making processes and advocacy services are well used within the home. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 3 X X 4 X Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 25 NO 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 YA28 Regulation 23 (1) (e) Requirement The home must ensure that there is sufficient space for service users to meet with friends and family in private Timescale for action 09/02/07 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 YA24 Good Practice Recommendations It is recommended that the flooring in unit 1C be replaced by something more appropriate for constant spillages. Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carwood Residential Home DS0000059615.V292570.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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