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Inspection on 14/09/05 for Claremont Nursing Home

Also see our care home review for Claremont Nursing Home for more information

This inspection was carried out on 14th September 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Staff said that the care of service users is very good. The home is a happy place and there is good interaction between staff and service users. There is good information available about the home. The admission process is thorough and residents` needs are fully assessed before admission. An enthusiastic activities coordinator provides a range of activities that are appropriate for the service users. Service users and relatives spoke well about the care and the food that is provided in the home. The personal care of service users including those in bed was seen to be to a good standard during this inspection. A good choice of meals are offered and residents said that they enjoyed the food. The meals provided in the home are considered to be to a good standard.

What has improved since the last inspection?

Service users wishes regarding terminal care and arrangements after death are being discussed and recorded. The numbers of staff who are attending NVQ training courses has increased. Residents and relatives meetings have been held.

What the care home could do better:

Staff said that problems with staffing at times has an effect on service users such as restricting the numbers who can accompany them on outings from the home. Management and staff lacked awareness that practices carried out to keep service users safe may impinge on service users rights. Care staff supervision has not been started. A second sluice and a third sling hoist are required in order to met the needs of service users. The redecoration of the home needs to be carried out more quickly.

CARE HOMES FOR OLDER PEOPLE Claremont Nursing Home New Street Farsley Leeds LS28 8ED Lead Inspector Susan Knox Unannounced 14 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Claremont Address New Street Farsley Leeds LS28 8ED 0113 2360200 0113 2360472 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Park Homes UK Ltd Mrs C Prior Care Home 39 Category(ies) of Old Age (39)_Physical disability (2) Terminally registration, with number ill (1) of places Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: PD places are for specified service users only TI place is specifically for named service user Date of last inspection 16 December 2004 Brief Description of the Service: Claremont is a converted, extended, detached property, situated near the centre of the village of Farsley. The home is close to local bus routes and within easy access of a mainline railway station and the main roads to Leeds and Bradford.The home was first registered in September 1991. It is owned by Park Homes UK Limited. Nursing care for up to thirty-seven older people is provided.Accommodation is offered in a combination of twenty-one single and eight double rooms; all bedrooms have en-suite facilities. Service users have a choice of two lounges, and there is a spacious dining room.Gardens are available consisting of lawns and an attractive enclosed garden to the rear, with level access from one of the lounges. Car parking is provided to the front of the property. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by one inspector and was between 9.30 am and 4.30pm. Ms Carole Prior registered manager was present. Time was spent talking to residents, staff and observing practice. Records including duty rotas, care records, recruitment records and staff training records were seen. Some bedrooms and other areas were checked. The majority of the requirements from the last inspection have been addressed. Requirements and recommendations from this inspection are included at the end of the report. Feedback was to Ms Prior and Mr Jason Sykes operations director. What the service does well: What has improved since the last inspection? Service users wishes regarding terminal care and arrangements after death are being discussed and recorded. The numbers of staff who are attending NVQ training courses has increased. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 6 Residents and relatives meetings have been held. 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. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-5 Good information is available about the home. Contracts are available and due to be amended. Service users and their families are given an opportunity to look round before deciding whether to move in. EVIDENCE: Brochures and other information about the home are freely available in the main entrance. The operations director said that Park Homes Ltd contracts for privately funding service users are being reviewed. One service user contract set up with a local authority was seen. This had no number of bedroom allocated recorded. This is a requirement. All service users are assessed before admission to the home to make sure that their needs can be met. Pre-admission assessments provided detailed information about the individual’s needs. One relative described how staff had visited to assess her relative before she was admitted. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 9 Service users said that either they or their relatives had come to look round the home before moving in. Intermediate care is not provided. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10, 11 Care planning is good apart from where records need to be more detailed. Health care needs are met but records must be consistent. Residents are treated with respect and their privacy maintained but the use of radios near bedrooms needs reviewing. Terminal care and arrangements after death are discussed with residents and their family. Staff do seek additional advice from other agencies. EVIDENCE: Three-service user’s care records were looked at. The care planning addressed the individual needs of the residents. Monthly evaluation takes place ensuring that changing needs are identified and appropriate action taken. Care planning was well documented and up to date. Recognised assessment tools are in use and risk assessments were in place. Where an assessment has identified that someone is a high risk, as in one case this was identified in a nutritional assessment, this must be followed through in the care plan. This should reflect the actions taken to address the risk. In this case it could be by providing high protein drinks or referral to dietician. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 11 The records showed evidence of service user or relative involvement in the care plans. This was also confirmed during discussions with one relative. Arrangements are in place for residents to access health care services as required. The home provides a range of pressure relieving equipment including specialist mattresses and cushions. Wound care records were seen for one service user. The tissue viability advisor had been contacted for additional advice about the progress of one wound. This is good practice. One assessment included sufficient clinical detail to show the wound was healing but another for the same service user did not provide the same detail. Details in records must be maintained consistently and provide a paper trail showing the progress of the wound. Feedback from relatives visiting the home was very positive about the quality of the care provided. Service user’s said that staff respected privacy and this was also confirmed in discussions with staff. They were able to give examples of how dignity and respect was promoted. However, it was noted that radios were available and switched on in one unit corridor. The music was more suitable for the staff than service users. It was difficult to see how this was for the service user’s benefit and how this fitted in with staff respecting the privacy and choice of service users. Service user’s wishes and preferences regarding terminal care and arrangements after death are currently being recorded in the care plan. A relative had completed this information in one. In one record there was a “do not resuscitate” entry. The organisation has recently introduced a policy and procedure about resuscitation issues. This needs to be checked to ensure that current policies are being followed. The home does seek additional help where necessary. This was evident in records and discussions about terminal care. The McMillan nurses were approached and staff had the out of office contact details for the local hospice. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 15. A planned programme of activities is provided for residents including trips out. The activities coordinator is enthusiastic about the service that she provides. Residents enjoy the food and are given a good choice of meals. Good relationships between service users and staff were evident. EVIDENCE: The home employs an activities coordinator who organises activities and outings for service users. Discussions were held with this member of staff who was very enthusiastic about her role. She said that she meets with all new residents and finds out about their interests and hobbies. She then tries to incorporate these interests into an activity plan. She was aware of those service users preferring to stay in their rooms and ensures that she visits. Some one to one work is carried out such as escorting one to the local bowling green that he used to visit. This is very good practice. The menus showed that a good varied, nutritional diet was provided. A menu was also available and up to date meals displayed on a board. A cooked breakfast or cereal can be provided. This was confirmed during discussions with service users. The main meal of the day was taken in the dining room with service users. The meal was well cooked, enjoyable and well presented. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 13 The dining room provides a pleasant environment and tables were laid appropriately. Service users spoke well about the quality of the food. Interactions between service users and staff were observed to be positive with lots of laughter and good humour. Care planning for one included choice to pick own clothes to wear. One issue observed during the meal was that all service users were wearing protective clothing. The manager stated that this was the service users own choice. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Comprehensive information is available and displayed about complaints procedures and enables service users and relatives to know their rights. Staff have received training in adult protection and abuse. The use of restraint without adequate records although for the best of reasons brings into question the effectiveness of this training. EVIDENCE: There is a detailed complaints procedure that is displayed in the home and included in the Statement of Purpose. A record is maintained of all complaints received including details of the investigation and the outcome. The manager said that no complaints have been made since the last inspection. The last complaint made to the CSCI was June 2005. This was partly founded. The operation director for Park Homes Ltd. said that the company has set up a complaints database in order to improve the monitoring of complaints received in all homes. Training sessions about abuse have been held in the home for staff. An Adult Protection session has been arranged for the end of September this year. The manager confirmed that these issues including whistle blowing are discussed at the initial interview, during induction and at staff meetings. Staff also confirmed this. This is also reflected in staff training records. It was noted that three service users were restrained in their wheelchairs by moving and handling belts. This was explained as in use for their safety in order to avoid falls. This was also confirmed in discussions with a relative. Within care homes various items of equipment are sometimes used to ensure Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 15 the safety of service users including bed rails, wheelchair harnesses and lap belts all are forms of restraint. Therefore the use of this equipment used in this context should be a last resort and only considered after a multi-disciplinary risk assessment. In the absence of this the risk to the service user of injury is increased by the use of unorthodox techniques. Only agreed restraints can be used and should not be in use without appropriate assessments, agreements and records. The use of the belts in question indicates a lack of understanding about restraint and further training must be provided in the home to all staff including management. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 24, 26 The home is intending to extend the building. There are no planned dates therefore decoration is required in a number of areas. New moving and handling equipment has been provided but an additional hoist would further meet the needs of service users. The second sluice in the home must be replaced in order to meet the needs of service users. EVIDENCE: An inspection of the building was not carried out other than in the rooms where discussions were held with service users. The manager advised that bedrooms were being decorated one at a time During discussions with one service user it was noted that decoration in one bedroom was poor. The service user said that she had been involved in choosing the colours for redecoration. This is good practice. Discussed with the operations director was the slowness in the work to redecorate. He said this was due to the proposed extension work to the building. No dates have been arranged for this work so it was agreed that Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 17 bedrooms that are not part of the forthcoming work would all be decorated within six months. Still outstanding from the last inspection is the second sluice. This is now obsolete and needs replacing. The home provides a number of specialist equipment such as nursing beds, hoists etc. A new hoist has been provided but a further sling hoist is required due to the needs of service users and the lay out of the building. An Environmental Health Officer has recently carried out a routine visit to the kitchen. The purchase of a new drop thermometer and probe was the only recommendations. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staffing levels are sufficient to meet service user’s needs the manager works hands on when required. NVQ training is on going. Recruitment procedures make sure that staff are suitable before they start work in the home but records must be available in the home for inspection. The home has a training programme to make sure that staff receive the training they need to carry out their jobs. EVIDENCE: A rota for the week of the inspection was provided. This showed that levels were appropriate. Occupancy was full. Three staff were taking sick leave and one was taking annual leave. Vacancies were for a part time carer on days and a part time kitchen assistant. In addition there was a full time night carer post. Staff did refer to the difficulties that occurred during annual leave and sickness times. The manager works alongside other staff in these cases. Recruitment to fill vacancies was taking place and she felt that this would settle down once the summer holidays were over. Due to the changes with staff the numbers with an NVQ level qualification has dropped. One member of care staff has an NVQ level 3, two have level 2, and two are currently undertaking level 2. Eight care staff have enrolled to start level 2 and three kitchen staff have enrolled for NVQ training. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 19 Recruitment practices were good. Staff files were well kept with evidence of application for CRB, identity checks, PIN number checks and references. But for one there was no evidence of CRB clearance or POVA first. The operation director said this would be at head office. In addition four staff had files elsewhere. Two were recruited by Park Homes Ltd and allocated to work at Claremont and two transferred from another home. Files had not been transferred. The home has a training and development manager who makes sure that staff receive the training necessary for providing care to older people. The training records showed the courses attended by staff. Staff confirmed that they had received training in health and safety, moving and handling, abuse and adult protection. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 38. The home is well organised and the registered manager provides effective leadership. Service users and relatives are encouraged to participate in all aspects of the home and there are good systems of communication in place. Care staff supervision if organised regularly would provide them with further support in caring for service users. The health and safety of service users and staff is promoted and protected. EVIDENCE: The registered manager is a qualified nurse and has completed four units of NVQ level 4 training. She works alongside other staff providing hands on care when required. She works supernumerary hours when occupancy levels are high. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 21 She provides effective leadership and is approachable to service users and staff. Meetings have been established for service users, relatives and management to meet regularly. Minutes were available and a relative also confirmed this. There is a named nurse system and key workers in place to ensure effective care. Service users and relatives had no problems in discussing concerns with management. The manager said that the home does not deal with any service users personal monies. Any valuables left for safekeeping is recorded and kept safe. The public liability certificate for the home was up to date and displayed as required. Still outstanding is the regular supervision of care staff. It was agreed with the manager that all would have received their first session by the end of December 2005. Information was available about maintenance checks. These were up to date for gas safety, portable appliance testing, fire extinguishers and legionella testing. An electrical wiring certificate was also up to date. The training and development manager has attended the fire-training course at Birkinshaw fire station. The maintenance staff confirmed that this has been cascaded to him. He as also had talks from a fire officer and the fire extinguisher company. Wheel chairs were clean and staff were using footplates when transporting service users. Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x x x 2 x 2 x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 3 3 3 1 x 3 Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 5 Requirement The providers must ensure that the contract includes the number of the bedroom accommodated. Submit a copy of the amended contract to the CSCI. The registered manager must ensure that care plans include the details and actions necessary to provide person centred care. The registered manager must ensure that staff routines do not infringe on service users choice such as radios playing. The registered manager must ensure that any practices considered to be restraint are carried out in accordance with procedures. Further training is required for all staff about restraint. The registered providers must provide additional moving and handing hoist. The registered providers must improve on the time taken to redecorate bedrooms all rooms completed within six months. The registered providers must provide a second sluice. The registered providers must ensure that all recruitment 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Timescale for action 31 October 2005 2. 7 17 31 October 2005 31 October 2005 With immediate effect. 3. 10 12 4. 18 13 5. 6. 22 24 23 16 31 October 2005 31 March 2005 31 October 2005 31 October 2005 Page 24 7. 8. 26 29 13 17 Claremont Nursing Home Version 1.40 9. 36 18 documentation is available in the home. The registered manager must ensure that care staff receive supervision six times a year. All staff must have received one session by the end of the year 31 December 2005 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 Good Practice Recommendations Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Claremont Nursing Home 20050914 Claremont Un Stage 4 S45220 V181336 J52.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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