CARE HOME ADULTS 18-65
Coronation Road, 63 Southville Bristol BS3 1AR Lead Inspector
Peter Still Key Unannounced Inspection 5th December 2006 14:30 Coronation Road, 63 DS0000026645.V321572.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 Coronation Road, 63 DS0000026645.V321572.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. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Coronation Road, 63 Address Southville Bristol BS3 1AR 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) 0117 9077217 0117 9709301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Miss Michelle Myra Clarke Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 6 persons aged 35 years and over Date of last inspection 16th November 2005 Brief Description of the Service: 63, Coronation Road is operated by Aspects and Milestones, which is a voluntary organisation. It is registered to provide personal care and accommodation for up to six people who are thirty-five and over and who have mental health needs. It is a settled household that would suit those who prefer a quiet and calm lifestyle. The home aims to encourage residents to live independent and fulfilling lives within a community setting. It is a four storey Victorian house overlooking the river, which blends in well with local surroundings. It is close to Bedminster shopping centre, major bus routes and local amenities. It benefits from a large front garden and smaller porch area to the rear with some parking space. The cost of placement is £550 per week. Additional charges are made for transport and chiropody services. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. Evidence was gathered from a number of different sources: - Information taken from the pre-inspection questionnaire - Information taken from all six resident survey forms - Information taken from four relative survey forms - Information taken from survey forms completed by professionals - Directly speaking with residents - Case tracking a number of residents (Focusing on the specific care of residents including admission and care planning with evidence from reading their files) - Speaking with care staff - A tour of the premises - Examination of some of the homes records - Observations of staff practices and interaction with the residents. The home manager was present during the inspection and assisted in the inspection process The overall analysis is that the home is a good place in which to live. The home continues to be settled and residents spoken with said they were very happy and gave praise for the staff team and the manager. What the service does well: What has improved since the last inspection?
Requirements and a recommendation from the last inspection had been responded to, which included good progress with Quality Assurance. The manager has continued to develop ways of running the home so that resident’s lives are improved and residents have confidence through a feeling of security. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 6 An initiative to encourage residents to be more involved in the purchase of food for the home was talked about enthusiastically by a resident. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 7 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 Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 8 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): 1,2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes admission procedure ensures that placement is only offered to those whose needs can be met. Contracts and the service user guide must be reviewed to ensure information about the services and arrangements fully informs prospective residents and protects existing residents. EVIDENCE: The last inspection recommended that the home’s brochure and service user guide be updated. This had been completed, with help from a resident who had taken very good photographs of the home, providing an excellent idea of what the home would be like to live in. The resident had been credited for the photography in the brochure. The contact details of the commission must be revised to bring the information fully up to date. The brochure contains information necessary for a prospective resident to make an informed decision about moving to the home however there should be details about rooms occupied. No new residents had been admitted since the last inspection. Of three residents files case tracked, one detailed assessment prior to admission had not been signed or dated in 2002.
Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 9 All residents contracts were signed and dated, however the contracts did not specify the room occupied. The service user guide and residents contracts must be reviewed to consider all the points within the national minimum standard about choice of home so that prospective residents can make informed decisions and be protected. One resident said on the survey form they completed for this inspection that “I visited a few homes before I came here but I didn’t like them so I picked this home after visiting three times” and the resident confirmed this at the inspection. Coronation Road, 63 DS0000026645.V321572.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): 6,7,9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in their care planning and decision-making and are supported in achieving goals to improve their lives. EVIDENCE: Resident’s spoken with talked about their busy lifestyle and decision making. The home has a good track record in supporting residents to encourage confidence and continual improvement in resident’s lives, which was found again at this inspection. Two residents spoken with knew whom their key workers were and said that they prepare the care plan with them. Care files case tracked, were up to date and contained key information, showing goals to be achieved and were person centred. The risk assessments, which had been reviewed, were detailed and identified risks for each resident. One risk assessment had been reviewed in June 2006. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 11 Resident’s responses to the pre inspection survey included points about choice and having needs met: “I have my tea early on a Sunday”; “There are some chores I do each week as part of living in a care home”. One resident told the inspector that they go out and buy the food for the home each week with another resident. One relative responding to the survey said their relative has “freedom, which she/he enjoys, to go out and about”. Another relative said “63 Coronation Road is providing him/her with a safe, friendly environment yet still enabling him/her to keep independence”. One resident spoken with talked about the way they were supported and said, “I have a sense of well being”. Coronation Road, 63 DS0000026645.V321572.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): 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have many opportunities and enjoy a stimulating and varied lifestyle. Residents enjoy a full involvement in menu planning, food purchase and good meals. EVIDENCE: Residents are encouraged to lead independent lifestyles. Staff review the daily life schedule at least six monthly and files case tracked showed evidence of this. Three files were case tracked and the well-recorded daily record for one resident showed that they had changed their mind about an activity, giving evidence of resident choice. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 13 One resident spoken with said they go for a walk every day and buy things from a local shop – “They know me now”. Residents personalise their rooms and one bedroom seen was very organised and yet showing many interests for the resident, including a well kept fish tank. Residents enjoy a range of activity including music and guitar, City of Bristol College, City farm, Bristol MIND and Hippodrome concerts. Residents talked about holidays, including a holiday abroad, where one resident thoughtfully brought back a musical wooden frog and table cloth for each of the dining room tables, making them look very homely indeed. Responses by relatives to the survey show contact with relatives and one said, “We can visit at any time”. Healthy eating was talked about and at a weekly meeting decisions were made about the menu. The diet and weight monitoring for one resident was considered in relation to the choice of food. Resident’s independence and equal opportunities was promoted strongly in the standard concerning meals. One resident chooses to self cater and have their own allowance for this. Other residents self cater on a day each week. A new initiative since the last inspection concerns two residents who go out each week to purchase the main shopping for the home. Once they have completed the shopping, they use the home mobile phone to ask staff to collect them with the shopping. One resident spoken with was enthusiastic about this role and the inspector considers the approach to the whole standard to be excellent. One resident said they agree menus at the weekly Sunday meeting, they talk about healthy eating, have salad and also that “if the fruit bowl goes down, we fill it up.” “I help with the cooking and I do my own cooking, we are lucky with the shops so near”. Coronation Road, 63 DS0000026645.V321572.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): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their needs will be met because the home has good care planning processes in place. Residents are well cared for. EVIDENCE: Three residents files were case tracked and were well recorded with good detail on key aspects. A photo of the resident was at the front of each file. There was evidence that one resident had chosen not to sign their care plan, for a review of June 2006. Another care plan was also well recorded and had been reviewed on 30/08/06. An optician was due to visit the home to support two residents the day after this inspection. A member of staff, talking about what was positive about working at the home said “I like it when I see residents getting on well, one resident used to spend all their time in their room and now goes out and about a lot and the resident has a meaningful life.” Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 15 The medication system and approach was reviewed and case tracked for three residents. Four residents self medicate, demonstrating support for residents responsibility and independence. The medication cupboard was kept locked, clean and well organised. A staff signature list was seen at the front of the medication book to show who had been responsible for medication and staff had signed the medication sheets correctly. A stock control was completed on a monthly basis. The risk assessment for one resident was seen and residents who self medicate keep their medication in a locked box in their bedroom. One resident spoken with said they collect their own medication from the local pharmacy, which was important to them with their independence and responsibility for their own health care. Coronation Road, 63 DS0000026645.V321572.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): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that any concerns they have will be listened to and acted upon. Residents will be cared for by staff that are aware of abuse issues and will safeguard them from harm. EVIDENCE: Two residents spoken with said staff listen to them and that they know who to talk to if they had a concern. One resident responding in the survey said, “Staff always listen to us”. Another said, “If we are unhappy we speak to the manager” and “We have a complaints book”. One resident spoken with said, “If I had a problem I would talk to one of the staff, I feel very safe.” The manager had undertaken a special training day for managers about the protection of vulnerable adults (POVA) on 06/11/06 and will cascade her learning to the staff team. No complaints had been received over the last twelve months. Survey responses from residents, relatives and professionals raised no concerns about abuse or neglect. One resident said “I don’t make complaints” and I would “Speak to a nurse” if I was unhappy. Another said staff always treat them well and “The staff are very good to get on with”. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 17 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): 24,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely and comfortable property, which meets their needs well and is in a good location to take advantage of all that Bristol offers. EVIDENCE: The inspector observed residents to be very much at home in their environment. The home was clean and tidy and one resident responding to the resident survey said, “The staff help us to keep the home fresh and clean. The staff do jobs as well”. The new kitchen was well used and appreciated by residents. The managers pre inspection questionnaire provided comprehensive detail with dates about the completion of all mandatory checks e.g. an approved electrical contractor completed their check on 27 October 2006. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 18 The inspectors tour of the building, noted some points for attention. The bathroom floor on the first floor will need replacing at some point since it is beginning to be stained. The ceiling in the second floor shower room showed signs of a very small area of marking as it joined the wall and a small crack may need attention. There were plans, noted in the last inspection, to replace the lounge carpet due to one small area of damage caused by watering a plant. Apart from this the carpet appeared to be in good order. A resident spoken with showed the inspector a small rug/cover they had made, which covered the problem area, with a small table on it. The resident was very pleased with the appearance and way of dealing with the damage and the inspector considers that the carpet should only be replaced if the residents want it to be or the manager feels it is not suitable. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 19 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): 32,34,35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An established staff team, who are trained and skilled to meet their needs, will care for residents. EVIDENCE: A stable staff team continues at the home, where four staff have achieved an NVQ and one member of staff holds City and Guilds qualification. The pre inspection document from the manager confirmed that 100 of staff have an appropriate qualification in social care and also first aid training. Since the last inspection, one member of staff had left and one had started. One member of staff spoken with said they had worked at the home for six years and had completed their NVQ level 3 and Protection of Vulnerable Adults training training. The last inspection found that there was some missing documentation concerning one member of staff. Necessary documentation had been at the office of the provider rather than at the home and this has been responded to. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 20 All key information about staff is now also held at the home. The file for the member of staff concerned was examined and found in order. The induction file for the new member of staff was also seen; it had been signed and dated. Monthly supervision had taken place and one record was dated 30/11/06. A member of staff spoken with said that teamwork at the home was very good. Supervision was helpful and positive; staff have delegated areas of responsibility. Staffing levels met resident’s needs on the day of inspection and the manager keeps staffing under review. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 21 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): 37,38,39,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Effective, positive leadership ensures that the management of the home is good and the home is run in the best interests of residents. A review of when to report incidents to the commission will help to protect residents. EVIDENCE: The manager continues to provide good leadership and had worked hard to make residents lives better over the last twelve months. One resident spoken with said the manager “is marvellous”. The support residents were given to promote confidence and independence was evidenced by residents, relatives and professionals. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 22 Relatives commenting in the survey response said: “My wife and I feel they are doing an excellent job”; “He/she has the freedom which he/she enjoys to go out and about”; “A safe, friendly environment yet still enabling him/her to keep independence”. One professional said: “Coronation Road manages to combine a feeling of professional care with a definite warmth and homely feeling, treating residents as individuals. It is clear that the residents value it very highly”. The manager provided good detail within the pre inspection survey she completed. This showed that all policy documents were being reviewed at appropriate times and were in the annual development plan dated 11/08/06 For example: Communicable diseases June 2006; health and safety work place 01/02/06; moving and handling 01/02/06 and racial harassment in March 2006. Staff sign, to show that they have read and understood policy and procedure, each year. Policy under review included: Adult protection; concerns and complaints; missing residents; medication; record keeping; sexuality and relationships; a new staff handbook about gifts was also due imminently. This report shows good evidence of residents being confident that their views are listened to. Significant progress had been made concerning quality assurance and self-monitoring. In September 2006, the provider produced a new quality assurance tool and the home is paired with another home for exchange monitoring visits, using the tool. There will be two visits a year, which will undertake a detailed inspection quality audit, including feedback from residents, staff and the manager. It will show strengths and areas for improvement and an action plan will be produced. The area manager will agree the plan with the manager to respond to the points. The manager showed the document to the inspector and will complete the task within the next twelve months. With such a robust response the last inspection report requirement about quality assurance, it was not felt necessary to repeat it. Satisfaction surveys had been repeated and the manager said she would include professionals in new surveys to go out. There was some evidence of equality and diversity noted in this report and the manager has attended a training day concerning racist incidents. The manager agreed to consider ways of promoting equality and diversity at the home and it is expected that the quality assurance work will help with this. The representative for the provider makes monthly unannounced visits, copies of which were sent to the commission. The manager said she found these helpful and that the representative was knowledgeable and supportive. Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 23 An incident at the home, involving the potential wellbeing of a resident, which occurred on 16/10/06 had not been reported to the commission and the manager agreed to do this through a Regulation 37 report. The manager must review the policy concerning reporting of incidents to ensure that all important information, which may effect the wellbeing of a resident is communicated properly to the commission. There was evidence that identified residents could be a challenge to the service. Staff supported one resident by changing their approach and the South Bristol rehabilitation team had provided guidance; the outcome for this and all residents had resulted in almost no challenging behaviour incidents within the last twelve months. On the day in inspection, the inspector found residents to be relaxed and very contented with their lives. Coronation Road, 63 DS0000026645.V321572.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 2 2 3 3 X 4 X 5 2 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 X 3 4 3 X X 2 X Coronation Road, 63 DS0000026645.V321572.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 YA1 Regulation 5(1)(f) Requirement The registered provider must ensure the service user guide includes the current CSCI contact details. The registered provider must report any event, which adversely affects the wellbeing or safety of a resident. (Review the reporting arrangements so that serious events are reported to the Commission) The registered provider must review the standard contract. (The bedrooms occupied by residents should be included in the contract) Timescale for action 31/03/07 2 YA42 37(e) 31/03/07 3 YA5 5(c) 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Coronation Road, 63 DS0000026645.V321572.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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