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Inspection on 11/04/06 for Clifton Manor Care Home

Also see our care home review for Clifton Manor Care Home for more information

This inspection was carried out on 11th April 2006.

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

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

Two of the residents and relatives spoken with said they liked the home. They gave very positive accounts of the kindness and commitment of the staff. One letter complimenting the staff was received coincidentally by the CSCI just 2 days before the inspection. It praised the staff on the attention given to female residents on Mothering Sunday. Three of the relatives said that they left the home following visits confident in the knowledge that their relatives were in capable and caring hands and that their every day needs were being met. Observations of care practice showed the staff consider the wishes of the residents; offer choice and communicate with them when carrying out their responsibilities.

What has improved since the last inspection?

The last key inspection took place on 25th July 2006, however an additional inspection took place on 2nd November 2005 to monitor progress made in meeting a number of serious concerns. These were found to have been addressed however a further five requirements were made. The new provider has taken steps to ensure these requirements are met. The home now benefits from a new nurse manager who has been in post for approximately 6 weeks. There is an accessible complaints procedure and the staff records are being maintained in accordance with the requirements. The manager has introduced a number of changes, which are already benefiting the residents. The frequency of meals and quality of the food provided particularly at tea and suppertime have improved. The comfort and dignity of female residents has been addressed. Staff have been instructed to dress people appropriately or use knee blankets. The provision of activities most afternoons enables the residents to participate in a range of activities. The staff`s responsibilities for ensuring that resident`s rooms are maintained to a higher standard have also been clarified. Proposals have been made to meet staff training requirements and more stringent recruitment procedures have been implemented. Audits are being undertaken to identify the shortfalls in meeting the National Minimum Standards and regulations. Although plans have been made to address these shortfalls some have not yet been achieved, as it is only a matter of weeks since the company was taken over. The progress made will be monitored by the CSCI.

What the care home could do better:

A more thorough appraisal of the planned improvements will be made at the next inspection. In the mean time the CSCI require confirmation of the plans to meet mandatory staff training requirements; to ensure that staff are well informed about the protection of vulnerable adults; and on the plans for the provision of a safe garden area for use by the residents.

CARE HOMES FOR OLDER PEOPLE Clifton Manor Care Home Rivergreen Clifton Nottingham NG11 8FZ Lead Inspector Sharon Rosenfeld Unannounced Inspection 11th April 2006 09:00 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 Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 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. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Clifton Manor Care Home Address Rivergreen Clifton Nottingham NG11 8FZ 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) 0115 9848485 0115 9845859 Manor Care Group Limited Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (1) of places Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users shall be with category OP, within the total number of beds a maximum of 1 bed may be used for the category PD 25th July 2005 Date of last inspection Brief Description of the Service: Clifton Manor Care Home (Nursing) is situated in the suburb of Clifton, southeast of Nottingham city. The home was purpose built. Accommodation for residents is on the ground and first floor of the home. The garden of the home is not currently accessible to residents. The home provides personal care and nursing care to up to 30 older people. One bed can be used for a person with a physical disability. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over 8 hours on 11th April 2006. There were 13 residents accommodated in the home. The company that operates the care home has recently been taken over. The new managing director shared her vision and plans for the home and talked about the changes that had already been put into place or were planned for implementation in the near future. A new nurse manager has been appointed and was present throughout the inspection. This inspection report communicates many of the plans for improvements to the home, some of which have already been partly implemented. The next unannounced inspection will check the progress of the proposed improvements. The inspection methodology used was ‘case tracking’ where three residents with different care needs were selected to have their care tracked. Their records were viewed and they were spoken with during the day. Four relatives and three staff were also spoken with. A partial tour of the building also took place. What the service does well: Two of the residents and relatives spoken with said they liked the home. They gave very positive accounts of the kindness and commitment of the staff. One letter complimenting the staff was received coincidentally by the CSCI just 2 days before the inspection. It praised the staff on the attention given to female residents on Mothering Sunday. Three of the relatives said that they left the home following visits confident in the knowledge that their relatives were in capable and caring hands and that their every day needs were being met. Observations of care practice showed the staff consider the wishes of the residents; offer choice and communicate with them when carrying out their responsibilities. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 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. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 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 Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 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 the following standard(s): 3 The assessments of individual resident’s needs are good and ensure that up to date information is available to inform care planning. The home does not provide intermediate care. EVIDENCE: The records of three residents were seen. These people case tracked receive funding from social services. Their records contained the appropriate community care assessments. Additional assessments had been undertaken periodically, to determine their level of need in the following areas: nutrition; moving and handling; mobility and risk of falls; the risk of developing pressure sores and infection; dependency; mental state and cognition. Greater consideration is now being given to the assessment of resident’s social needs Regular activities are now planned as a result. Religious preferences are also acknowledged and planned for more successfully.. The residents’ needs were reviewed at appropriate intervals. Each file contained a care plan that explained how their identified needs would be met. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 9 One person is a younger adult and although her nursing needs are being met by the home, she has expressed a wish to move to alternative accommodation. The home therefore has a responsibility to refer her to social services for reassessment. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10. The care plans and records effectively communicate how personal and nursing care needs are to be met. The residents are treated respectfully EVIDENCE: The care plans are individually written and needs led. Some elements of the care plans identify the resident’s remaining strengths and skills such as their ability for self-care. This is good practice and it is recommended that this should be extended to all aspects of the social and personal care planning. The care plans also describe how staff should manage situations when a person becomes upset or irritated. It is recommended that possible triggers are identified and are also recorded. There was no evidence that residents or their representatives had opportunities to be involved in the development and review of their care plan. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 11 The three care plans seen had been reviewed on a monthly basis and updated where necessary. The staff have access to the care plans to inform their practice. They record their day-to-day observations and how residents needs have been met in daily records. There was clear evidence of the involvement of external healthcare professionals such as tissue viability nurses, doctors, dentists and private chiropodists. There was no evidence seen that referral to NHS chiropody has been made for people who have, for example, diabetes. The new manager had also made contact with an external support group with specialist knowledge of the physical disability of one resident. This is good practice. The medication practices within the home appear to be well managed. The homes procedure was not examined on this occasion. None of the residents are currently prescribed controlled drugs. The home has made appropriate arrangements for the receipt and disposal of medicines and clinical waste. Observations of care practice confirmed that the staff consult with residents and offer them choices. Two relatives spoken with confirmed their pleasure with the quality of care provided and said they are kept informed about any changes in condition. The staff were observed to knock on residents doors before entering. They also explained the tasks they were undertaking with residents, for example, when assisting to move using a hoist. Three of the nursing staff act as ‘Link’ nurses for the home. This means they attend meetings with external professionals such as continence advisors, and tissue viability specialists and bring back to the home information and updated skills. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, 15. Improvements have been made to the provision of activities within the home and in meeting religious needs. Meals are nutritious and balanced and choice is offered. EVIDENCE: An activities co-ordinator has been employed to facilitate social events and activities each afternoon, during the weekdays. This did not take place on the day of the inspection however. One person said they had enjoyed painting plant pots and was looking forward to planting Marigolds in them on another occasion. The staff stated that the introduction of activities has benefited some of the residents who have enjoyed the variety of activities offered so far. The manager has arranged regular visits to the home by the local Methodist Minister and Catholic Priest. Four relatives were spoken with. They all praised the work of the staff. One family said the quality of the care was ‘second to none’. They attend the home everyday and often participate in the delivery of care to their mother. They stated they had never had cause to complain and find the staff kind, hardworking and approachable. Another visitor confirmed there are ‘open’ visiting times and said the staff were very friendly. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 13 Throughout the day staff were observed to offer residents a range of choices. This was particularly evident at meal times. Although there is a choice of two main meals at lunchtime, one person did not want either and was offered other options by the staff. The staff appropriately supported and encouraged people who required assistance to eat. A variety of drinks were available at and in between meal times. The CSCI has produced a report on the quality of meal times in care homes and the attention of the manager was drawn to this document. Some people choose to spend time in their rooms at particular points in the day. There is separate space from so that residents can meet in private with visitors. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 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 the following standard(s): 16, 18. Improvements in the way that complaints are addressed have been made. The lack of staff knowledge regarding adult protection procedures and definitions of abuse could compromise the safety of residents. EVIDENCE: One complaint has been received by the CSCI since the last inspection took place. This was referred to the provider to investigate within given timescales. The complaint was not upheld on this occasion and written justification of this was received and agreed by the CSCI. There is an accessible complaints procedure giving clear guidance on what to do and who to contact with concerns. Interviews with the staff evidenced that they were not conversant with adult protection protocols and procedures. Although they had some awareness of ways in which residents might be abused, their knowledge of this must also be improved. When asked they did not know what the Whistle Blowing procedure was. The contact details of the Nottinghamshire Committee for the Protection of Vulnerable Adults were shared with the provider and manager. This will enable them to access up to date policies, procedures and training. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19, 26. Planned improvements to the environment and the garden will enhance the experience of people living at the home. There are no serious matters outstanding that would place people at risk however the garden is currently in accessible. EVIDENCE: A person is employed to carry out routine day-to-day maintenance and monitoring work at Clifton Manor Nursing Home. The systems such as gas and electric, and the equipment such as hoists and the lift are serviced and maintained by qualified technicians. Evidence was seen that this is up to date. Evidence was not seen that the building complies with the local fire service requirements. The condition of the home is generally good. The cleanliness of the home has improved and new carpet cleaning equipment has recently been purchased. Residents can access all parts of the home, however not all parts of the garden are safe to access. There is a plan to design a new garden, however it is proposed that this will be situated behind the adjoining residential Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 16 care home and therefore will not be easily accessible to the people who live at the nursing home. Further planning of the garden at the nursing home is required. Recent improvements have also been made to the laundry facilities. The number of complaints about this service has reduced and fewer clothes are being mislaid due to better labelling. The laundry is sited away from areas where food is stored and prepared. There is a system in place to manage infected material and clinical waste. A person is employed to do residents laundry and she has received infection control training. There were no offensive odours at the home. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. The procedures for the recruitment of staff have been tightened to offer more protection to people living at the home. The new provider has plans to address the gaps in staff training. EVIDENCE: The manager has records of the residents dependency needs. This will make it easier to monitor if the staffing levels are appropriate. In addition to the qualified nurse on duty, there are three care staff on duty in the morning and two in the afternoon. The staff confirmed that the new provider has addressed the pressure on them to work longer additional hours to cover staff shortages. Agency staff are now more widely used and recruitment is taking place. The use of agency staff has not adversely affected the continuity of care as the same people are used are used whenever possible. The manager has approximately two supernumerary hours each day to undertake administrative and managerial tasks. This time is also used to assess the needs of referrals made to the home. This needs to be kept under review to ensure that her responsibilities can be managed in the time allocated. It is acknowledged that the other support staff such as a part time administrator and maintenance worker assists this. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 18 The home had not achieved the required ratio of 50 trained members of care staff to NVQ level 2 or over by 31st December 2005. The provider does however have plans to achieve this qualification target therefore a requirement will not be made at this inspection. The CSCI will however assess the progress of the provider in meeting this standard at the next inspection and take appropriate action necessary to ensure that residents are cared for by staff that are appropriately trained to meet the individual needs of the residents. A new induction programme and record has recently been introduced. This is in its infancy and cannot be assessed thoroughly until it has been used on new recruits to the staff team. This standard will therefore be more thoroughly assessed at the next inspection. The staff files contain some gaps in information. The provider and the administrator have informed the staff in writing about the information required with timescales set for this to be made available. The staff confirmed that more robust recruitment practices are in place and knew that no one was allowed to commence work without the necessary Criminal Records Bureau and or Protection of Vulnerable Adults checks and supervision. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. The residents now benefit from having a nurse manager with a clear sense of direction and leadership. The planned quality assurance programmes will enable residents and other stakeholders to influence practice at the home. The home generally has systems in place that promotes the health and welfare of the residents and staff. EVIDENCE: An audit of the mandatory staff training revealed some gaps. The new provider who is putting measures in place to ensure they are addressed had already identified these. The manager is now qualified to provide moving and handling training to the staff team. Fire safety training is planned to take place for all staff in the next two weeks. The staff still require first aid, food hygiene and infection control training. When interviewed the staff confirmed Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 20 that the new provider appears committed to the provision of training and has already made progress in this area. The homes electrical and gas systems are maintained on an annual basis. The maintenance worker regulates the water temperatures and the manager of the Clifton Manor Residential home is responsible for the tests for Legionella at both homes. The lift has recently been serviced and the lifting equipment at the home is due to be serviced within the next week. CSCI’s new format for the Regulation 37 notices were shared with the manager and it is recommended that they be used from now on. Wherever possible the residents or their relatives manage their own personal finances. Some cash sums are managed for the payment of hairdressing and chiropody etc and records are kept about these. The manager must apply to the CSCI for registration in accordance with Section 11 of the Care Standards Act 2000. The new provider is implementing new quality assurance procedures. The views of residents, staff, relatives and other stakeholders will be captured through the use of questionnaires. The responses will be analysed and used to inform future practice at the home. The success of this system will be assessed at the next inspection. Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 X 18 1 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 22 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 OP18 Regulation 13(6), 18(1) Requirement Timescale for action 30/05/06 2 OP19 23(2)(o) 3 OP28 18(1) 4 OP38 18(1) The registered provider must ensure that all staff are knowledgeable about the different types of abuse and about their responsibilities under the Nottinghamshire Committee for the Protection of Vulnerable Adults policies and procedures. The registered provider must 31/05/06 produce a plan with timescales to make the grounds of the nursing home safe for the use of its’ residents. A copy of the plan must be sent to the CSCI. The registered provider must 31/05/06 produce a plan with timescales and names of staff on how 50 of the care workforce will achieve qualification to NVQ level 2 or equivalent. A copy of the plan must be sent to the CSCI. The registered provider produce 31/05/06 a plan with timescales and names of all staff to confirm the arrangements for all staff to receive training in moving and handling; first aid; infection control and food hygiene. A copy of the plan must be sent to DS0000026432.V288908.R01.S.doc Version 5.1 Clifton Manor Care Home Page 23 the CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Clifton Manor Care Home DS0000026432.V288908.R01.S.doc Version 5.1 Page 25 - 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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