CARE HOMES FOR OLDER PEOPLE
Dalemain House 19 Westcliffe Road Southport Merseyside PR8 2BL Lead Inspector
Elaine White Unannounced 7th June 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. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Dalemain House Address 19 Westcliffe Road Southport Merseyside PR8 2BL 01704 568651 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) Mr Glen Alan McNair Mr Glen Alan McNair Care Home 24 Category(ies) of Old age 24 registration, with number of places Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include to up 24 Old age Date of last inspection 11th October 2004 Brief Description of the Service: Dalemain House is a residential care home, which provides personal care and support for up to 24 older people. There were 20 residents accomodated at the time of the unannounced inspection. The home is owned and managed by Mr Glen McNair. The home is located in a residential area close to the town of southport, which can be reached by the local transport services. The home is a large converted house. All areas are accessible by a passenger lift and there is ramped access to the front garden and small car park. Grab rails are available throughout. Call bell systems are in all rooms. Community facilities include a large comfortable lounge, dining room and a well maintained enclosed garden. Accomodation includes 11 single rooms, 9 with en suite and 5 en suite double rooms. Only 1 double room is presently accomodated by 2 residents. Since the last inspection the home has made progress to improve the standard of care and the environment. Positive comments were received from residents, staff employed and visiting relatives spoken to. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There has been one visit to the home since the last inspection in October 2004. This was to investigate a complaint, which resulted in action required by the home to improve the standard provided. The home resolved the issue within the time scale required. A tour of the building was conducted. Case tracking was conducted on 3 residents to assess the care and support provided. A selection of care, staff and home records was also viewed. The manager, care manager, deputy manager, 6 staff, 3 of the 20 residents and 4 relatives were spoken with and their views obtained of the home. Satisfaction comment cards were also given to residents and relatives to complete at their leisure. Comments received have been favourable regarding the home and the very caring nature of the staff and the improvement in the standard of the environment and atmosphere in the home. What the service does well:
Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 6 Since the last inspection the home has made a number of improvements to meet the requirements and recommendations made in the last report. The home has demonstrated that it aims to improve standards in both care practices and the environment. The home had a pleasant relaxed atmosphere and at the time of the inspection all areas viewed were clean and hygienic. Fresh flowers are displayed around the home and the well maintained garden provides a pleasant area for residents and visitors to sit. The home welcomes visitors and residents and relatives spoken to confirmed this. Comments made from a resident included “we had afternoon tea in the garden yesterday and my visitors joined in”. “I call every day and the staff are always pleasant”, (relative). Staffing levels are being maintained and new staff have been employed. The home now employs sufficient care, domestic, laundry, kitchen assistants and management to meet the needs of the residents. Residents and relatives spoke highly of the care they received and were pleased with the staff who they found very hard working and polite at all times. One relative spoken to said, “The staff are very polite and responsive and will do anything you ask of them”. New staff spoken to confirmed that the home is organised and provides support and supervision when required. Comments from one new carer “ I have worked in many care homes and this is the best. The home is warm, friendly and everyone is welcome here”. Records viewed and staff, relatives and residents interviewed confirmed that the health care needs of residents are being met and comments included “ the staff are always approachable and very caring”. (Resident). “My mum needed a chiropodist and they sorted it”. “The care is second to none” (Relatives). Care staff receive a verbal report at the beginning of each shift and report any changes that affect the well being of the residents. The care manager and /or deputy manager assess all prospective residents and a detailed plan of care is then written after admission. Specialist equipment is in place to meet the needs of the residents, i.e. one resident requires bed rails and air mattress. These have been provided in consultation with the relative/resident/district nurse and documentation is in place to confirm their agreement. The district nurses attend when required to meet the resident’s needs. Nutritional assessments are in place and fluid intake and residents turning times recorded. All visits by health care professionals and personal hygiene routines i.e. baths, oral care, hair care are recorded. The home seeks the views of residents/relatives and other visitors. A recent survey has been distributed to relatives for comments and relatives have been invited to attend the reviews of their relatives by letter. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 7 What has improved since the last inspection?
Since the last inspection the home has made a number of improvements to meet the requirements and recommendations made in the last report. These include decoration of bathrooms and top floor landing, new bedding, new carpets on top floor and completion of the new laundry. Fresh flowers are displayed around the home and the well maintained garden provides a pleasant area for residents and visitors to sit. Staffing levels have been improved through the employment of new staff and training is in place. Residents and relatives spoke highly of the care they receive within the comfortable accommodation. Relatives commented, “I am very pleased with the improvements and all the relatives have made comments about this”. “The home is better organised, brighter and I have been visiting for five years”. They were pleased with the staff who they found very hard working and polite at all times. One relative spoken to said, “The staff are very polite and responsive and will do anything you ask of them”. New staff spoken to confirmed that the home is organised and provides support and supervision when required. A carer who has worked at the home for a number of years said, “It is now very organised. The staff are more settled. The hygiene standards are brilliant and the residents are being cared for. It is lovely working here now and I get support and supervision”. Relatives and visitors are made welcome and this was observed throughout the inspection as visitors were offered a drink and chatted freely with the staff and residents. Residents and relatives spoken to also confirmed this. Care files have been improved and the recordings systems are more organised. Records viewed demonstrated this. Care staff receive a verbal report at the beginning of each shift and report any changes that affect the well being of the residents. The care manager and /or deputy manager assess all prospective residents and a detailed plan of care is then written after admission. Specialist equipment is in place to meet the needs of the residents, i.e. one resident requires bed rails and air mattress. These have been provided in consultation with the relative/resident/district nurse and documentation is in place to confirm their agreement. The district nurses attend when required to meet the resident’s needs. All visits by health care professionals and personal hygiene routines i.e. baths, oral care, hair care are recorded. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 9 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 10 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 Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 11 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) 1,2,3,4,5,6 A statement of purpose and service user guide is in place to provide information to prospective residents and relatives. However this is in the process of being updated in view of the staff changes. Each resident has a written contract/statement of terms and conditions. Full assessments are obtained prior to admission. The home encourages prospective residents and relatives to visit the home prior to admission. EVIDENCE: The statement of purpose and service user guide is in place, however this is presently being updated in view of the recent staff changes and developments. A copy of the most recent inspection report is available for residents/relatives and visitors to view. A number of contracts were viewed for residents placed at the home. Individual records are kept for each resident and the care manager/deputy manager completes the assessment documentation prior to admission. Assessments completed by social workers were also on file. The information is then used to form the basis for the resident’s plan of care.
Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 12 Staff spoken to were able to describe the care needs of the residents and were observed to respond to their needs when assistance required. Staff commented that there is enough information recorded to enable them to meet the resident’s needs. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 13 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) 7,8,9,10 The residents care plan identifies the health care needs required; however the home must demonstrate that these are reviewed monthly to reflect changing need. Records viewed, discussion with relatives, residents and staff confirmed that care needs are being met. Residents are protected by the home’s policies and procedures for dealing with medication. Residents feel they are treated with respect, dignity and their right to privacy is upheld. EVIDENCE: Each resident had an individual plan of care that identified relevant aspects of health, social and personal care. The care plans were detailed, easy to read and staff spoken to confirmed their understanding of the care needs of the residents. The care manager is in the process of reviewing all the care plans in place and has written to relatives to invite them to attend. A copy of the letters was viewed. It was noted that one residents review had not been provided. The home must ensure that all care records are kept up to date. The resident’s or relative’s signature to these changes would be beneficial to ensure information is kept up to date and accurate.
Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 14 The home must ensure that all care plans are reviewed monthly to assess changing need and identify the involvement of other health care professionals were required. One resident is receipt of weekly visits by the district nurse to monitor her progress due to a period of poor health. The family expressed that they are very pleased with the care and support provided “The carers are excellent and the care is second to none. My mum has been here 5 years and I want her to stay here”. The resident has been provided with all the necessary equipment to meet her needs and records viewed demonstrated that her care needs are continually monitored with support from health care professionals. The home has policies and procedures in place for medication. All medication administered is accounted for. Staff have information available to them on the Standards required and any allergies the residents may have. Sample signatures are in place for those staff responsible for medication. A formal controlled drugs record was required during the inspection and the care manager purchased this and the system put into place. Care files included information regarding helping residents who require help with walking and transferring from chair to bed (including the provision of manual handling equipment). Dietary provision and social needs were also recorded. Risk assessments are in place and viewed on resident’s files. Observation and relatives, residents and staff spoken to demonstrated that dignity and respect is maintained. Staff were observed to knock prior to entering rooms and spoke politely to residents and visitors at all times throughout the inspection. Relatives and provided positive comments on the staff employed. “The staff are very responsive and will do anything”. “The staff are very pleasant and the atmosphere is lovely”. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 15 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) 13,14,15. The home encourages contact withy family/friends and the community. The residents are helped to exercise choice and control over their own lives. The daily life and routine in the home is flexible to suit individual needs. Meal times are well managed and provided in comfort. EVIDENCE: Menus are provided on a four weekly cycle and are changed regularly. All residents interviewed stated that they were very pleased with the meals and were observed to enjoy the main meal of the day at lunchtime. The menu offered a good choice of hot and cold meals 3 times a day with light refreshments at other times. Special diets are catered for and recorded in their plan of care. Meals are served at set times however arrangements are flexible to suit individual needs. Some residents requiring assistance at meal times and this was provided in a discreet fashion. Some residents prefer to receive their meals in their rooms and this wish is respected. Thoughout the inspection relatives and friends visited the home and were observed to be greeted politely by the staff. A number of relatives were spoken to and provided positive comments. ‘The staff are very good’. ‘The atmosphere is lovely’. ‘The staff are very approachable . I call almost every day’.
Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 16 Discussion with staff, manager, residents and relatives confirmed that activities are in place. These include quizes, bingo and outside entertainers. Staff, residents and relatives interveiwed commented on the pleasant afternoon they had yesterday when they had afternoon tea in the garden. Staff commented that activities are provided “but not set in stone. If they don’t like it then we will change it”. Surveys and relative and resident meetings take place to enable them to comment on the care and support provided. Survey forms for relatives were being distributed at thye time of the inspection. The home has a large enclosed garden, which the residents can use in the summer months and a number of residents and realatives used this area to sit and chat during their visit. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 17 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 The home has a complaints policy and procedure in place and will listen to and act on complaints made. EVIDENCE: Since the last inspection a visit has been made to the home to investigate complaints made. The home responded to the complaint investigation, the findings and effectively resolved the issues in the times scales set. All complaint are recorded and the procedure is contained within the statement of purpose. Residents and relatives interviewed commented ‘ The staff are excellent and very approachable. If I had any complaints I would always talk to the staff’ (Relative). ‘If I wasn’t happy I would tell the staff’. (Resident). Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 18 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) 19,20,25,26. The layout and location of the home is suitable for older people. Surroundings are comfortable, clean and homely. Communal facilities both inside and out are accessible. EVIDENCE: Since the last inspection the home has improved the standard of hygiene, completed redecoration in the bathrooms and top floors, new bedding for residents, replaced carpets on the top floor and the completion of the new laundry. Staff, residents and relatives interviewed on the improvements in the home, made positive comments. “The hygiene standards are brilliant now”, (staff). “I am very pleased with the improvements. All the relatives have been commenting”,(Relative). “My room is lovely and clean”, (Resident). The communal areas and a number of private rooms were viewed and showed that the home provides a comfortable, homely setting for the residents. The garden is well maintained and is used often by residents and their visitors to sit and chat. This was observed on the day of the inspection. Radiator covers are in place in most areas, however, there are 3 rooms on the top floor, which
Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 19 do not have this facility. This was discussed with the manager and risk assessments are to be provided for the 3 residents. Grab rails are in place throughout and equipment is available to encourage independence. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 20 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) 27,29. Sufficient numbers of trained staff are deployed to meet the needs of the residents. Recruitment procedures must be robust to safeguard and protect the people living in the home. EVIDENCE: Files viewed demonstrated that the home needs to be more robust in their recruitment procedures and ensure checks to are made to safeguard the protection of residents. Protection of Vulnerable Adults [POVA] checks and Criminal Records Bureau checks at enhanced level were available for some staff but not all staff employed. Written references must be sought and this included information from the most recent employer. Records viewed, staff, residents and relatives spoken to confirmed that sufficient staff are on duty to meet the needs of the residents. Domestics, laundry assistant, kitchen assistants are employed in addition to care staff. Relatives commented, “There are plenty off staff”. Residents interviewed were complimentary regarding the standard of care they receive by staff and the very caring and kind approach offered to them. A resident said ‘the staff are very good and polite ’ and direct observation of the staff supported this view. Staff were seen working as an effective happy team and a pleasant atmosphere was in place. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 21 Discussion with staff and personal files viewed showed that training is given and a number of care staff interviewed are taking their National Vocational Qualifications [NVQ] in care. The home would benefit from a training matrix to demonstrate training received and training required. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 22 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) 32,33,38 The home involves residents and relatives in the way the home is managed by consultation via surveys and meetings. The home must ensure that all certificates are in place and fire training is provided for all staff to ensure a the health, safety and welfare of the residents. EVIDENCE: Discussion with staff, residents and relatives provided positive comments on the improvements in the staffing levels, pleasant atmosphere in place and how the home is more organised. The manager provides day-to-day hands on support. The home employs a care manager, who assesses new residents and deals with administration, a finance person and a deputy manager who manages staff and monitors care practices. The views of relatives and residents are sought via surveys and meetings. This enables the home to make improvements and develop the service to meet their needs. Accidents and injuries are reported and recorded. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 23 The manager must ensure that all certificates are up to date for services and that fire training is in place for all staff. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 24 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x x x 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 3 x x x x 2 Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 25 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans are reviewed monthly and records made. The registered person must provide risk assessments for 3 residents pending the fitment of radiator covers on the top floor. The registered persom must ensure that a robust recruitment procedure is in place and CRB checks and 2 written references are in place for all staff prior to empolyment. The registered person must ensure that an up to date gas certificate is in place and fire training is provided for all staff. Timescale for action 31st July 2005 31s5t July6 2005 31st July 2005 2. OP25 23 3. OP29 19 4. OP38 23 31st July 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. 2. Refer to Standard OP1 OP30 Good Practice Recommendations Theb statement of purpose and service user guide to be updated to reflect the staff changes. The home should develop a trainintg matrix to identify
F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 26 Dalemain House staff training completed and required. Dalemain House F53 F03 S5320 Dalemain House V223885 040505 Stage 2.doc Version 1.30 Page 27 Commission for Social Care Inspection Burlington House South Wing, 2nd Floor Crosby Road North, Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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