CARE HOME ADULTS 18-65
Dalewood Respite Care 1 Dalewood off Chiltern Way Buckskin Basingstoke Hants RG22 5EG Lead Inspector
Mrs Pat Hibberd Unannounced Inspection 13th March 2007 09:30 Dalewood Respite Care DS0000037131.V326865.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 Dalewood Respite Care DS0000037131.V326865.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. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Dalewood Respite Care Address 1 Dalewood off Chiltern Way Buckskin Basingstoke Hants RG22 5EG 01256 332215 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) lbeech@hants.gov.uk Hampshire County Council Mrs Laraine Susan Beech Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th December 2006 Brief Description of the Service: Dalewood is a care home providing respite care for up five adults with a learning disability. It is situated in a cul-de-sac in Kempshott, Basingstoke. The aim of the service is to provide a flexible, accessible, positive, enjoyable and individualised short-term break for service users. Dalewood can accommodate up to two service users on the ground floor who have physical needs and use a wheelchair. The current service user contribution per nights stay ranges from £4.81 £7.22. The Registered Manager provided this information during the visit to the service. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to the Commission for Social Care Inspection (CSCI) and a site visit to the home on 13th March 2007. During the site visit the inspector spoke with care staff on duty, spent time with one service user and discussed all aspects of service provision with the manager. CSCI surveys were sent to the Home prior to the visit. However, none of the surveys had been returned on the day of the visit. The interaction between the service user who was Home and staff were observed throughout the visit. A tour of the building was made and documents relating to the running of the home were inspected during the visit. What the service does well:
An experienced and effective Registered Manager runs the home with good communication between staff, service users and relatives. The service is service user focussed with people able to make decisions and exercise their rights being very much a focus in the home. It was evident that this gives service users ownership of the home. Policies and procedures for recruitment and training of staff are in place. This promotes the safety and well being of service users. There are good care planning and risk assessment systems, which are regularly updated to inform staff of the support service users need. Service uses are provided with good support to make decisions about which activities to participate in and a wide range of activities are offered. The manager ensures relatives are kept well informed of events at the home through personal contact. Good support is provided to meet the personal and health care needs of service users and medication is safely stored and administered. The home is generally well maintained and provides a homely environment for service users. There are good staff recruitment and training programmes, which help to protect service users. The manager uses feedback from service users and their relatives to plan improvements to the service provided. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Dalewood Respite Care DS0000037131.V326865.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 Dalewood Respite Care DS0000037131.V326865.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): Standard 2 was inspected on this occasion. Quality in this outcome area is good. The admissions procedure ensures the home only admits service users whose needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager Mrs Beech is responsible for undertaking the initial assessments of all prospective service users following a referral through Adult Services and receipt of a Care Management assessment. The assessment includes their care needs, goals and social plans during their stay. Details also include any transport arrangements, which room the service user prefers as well as the objective of their stay, for example, a break for their carer or to improve their independent living skills. The staff team have also introduced “theme” weekends for example a French weekend was recently held when service users if they so choose could experience food and gain an understanding of the lifestyle. Where possible service users can choose to take their respite stay with friends. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9 were inspected on this occasion. Quality in this outcome area is good. The home has good care planning and risk assessment systems, which are regularly updated and reflect the support that service users need. Good support is provided to help service users make decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The personal files of three service users were inspected during the visit all of which have varying and a diversity of needs. Each service user had a care plan that was developed from their initial needs assessment and was regularly reviewed, either yearly or as needs of the individual changes. As the service provides respite for individuals the manager explained that a review of the care plan can take place on each visit if the needs have altered in any way. This is with a view to ensuring the appropriate staff support is provided and, the environment is still suitable for the individual.
Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 10 Care plans contain details of how service users should be supported to make decisions. One example related to the support needs and preferences of a service user as to choices they may make and support they require when accessing the community. Another related to personal care and the service users preferences with regards to which staff should undertake specific tasks. It was further evident that staff enable individuals to make decisions about activities they take part in by using makaton, verbal communication and objects of reference that have been developed for some of the service users. However, one area that is to be commended is the work undertaken by the staff team in producing a range of information in a pictorial format to enable service users to be informed as to service provision and, ensure communication is of a high standard and to the benefit of service users. Staff support to the service user at Home was observed during the visit and was provided in a positive and friendly manner. It was evident that their needs were being acknowledged and responded too. In discussion with the service user they indicated that they were very happy staying at Dalewood for a break and said “ I want to come here again” and “the staff are good I like them they help me “. The individual was happy to show the inspector their bedroom and the recently refurbished bathroom that has been extremely well adapted to provide bathing for wheelchair users. Risk assessments were in place for in all files viewed. These documents set out the assessed hazards to service users and action to minimise the risk of harm. The risk assessments had also been regularly reviewed as required. Staff spoken with had a good understanding of the contents of the care plans and risk assessments and were able to give explain how the care plan was put into practice. One example being the support needs in the Home and community of service users with complex learning and physical disabilities. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16 and 17 were inspected on this occasion. Quality in this outcome area is excellent. The home provides excellent support for service users to take part in suitable activities, to maintain relationships with family and friends and provides good food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection there was one service user at Home and four attending day services. The individual at Home was preparing to go out and told the inspector that they were going to have their lunch out and do some shopping. It was evident from discussions with staff and care plans viewed that service users are supported to take part in a range of educational and leisure activities with all individuals having access to the local day centre for activities of their choosing. Service users’ files contained details of activities they had taken part in, including board games, puzzles, TV /DVD/Music, cooking, arts and crafts, attending the local day service, swimming and local community facilities.
Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 12 Themed weekends have been introduced of which the inspector was shown a range of photographs that have been taken of the weekends. Staff indicated that the photographs have enabled service users to remember and discuss what they enjoyed and what they would like to do again. Details of the support service users need to complete household jobs, such as cleaning and cooking, are detailed in their care plans. Further pictures have been taken of tasks that have been broken down to enable service users to gradually gain new skills and achieve their potential whatever that might be. The home has a menu that takes into account the likes and dislikes of service users and provides a varied and balanced diet and is produced in a pictorial format. Mealtimes are flexible to fit in with service users’ activities and the kitchen was well stocked with a variety of good quality food. The service user at home indicated they liked the food and always had a choice. Facilities for service users to make drinks and snacks are available although all service users would require various levels of support. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 13 Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were inspected on this occasion. Quality in this outcome area is good. The home provides good support to meet the personal care and health needs of service users. The medication systems in the home are good and protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of the personal care support service users need are set out in their care plans. Staff spoken with demonstrated a good understanding of the needs of service users and how they should be met. One service user explained how they were supported with their personal care of which they confirmed was provided in a respectful and dignified manner. Records are held of service users’ health services, including GP, dentist, optician, psychologist, psychiatrist and occupational therapist. The records kept included details of any advice given by the practitioner with health professionals visiting service users during their respite stay if required. Medication was stored in a locked cabinet in the kitchen and medication administration records had been fully completed.
Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 15 Each service user brings sufficient medication in to the Home with them to receive during their stay. Stocks are not therefore kept in the Home but returned to the service users when they leave the Home. All staff administering medication have undertaken training. The manager has also purchased a medication book which details information relating to a range of medication, their effects and their purpose. Staff have found this extremely useful in gaining further understanding of what a particular medication is for and how it might affect an individuals behaviour. There are currently no service users who self medicate. Dalewood Respite Care DS0000037131.V326865.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): Standards 22 and 23 were inspected on this occasion. Quality in this outcome area is good. Service users are confident their complaints will be taken seriously and acted upon and the home has good adult protection systems, which help to keep service users safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure available, which sets out who will deal with a complaint and how long the provider will take to respond to a complaint. The procedure has been supplied to all service users in a pictorial format to aid understanding with one service user explaining to the inspector who they would talk to if they were unhappy with any aspect of their care. The procedure is provided to families and an independent advocate is available to support individuals if required. There have been no complaints received by the Home or commission during the last 12 months. The home has an adult protection policy and a copy of the local authority adult protection procedures. Staff have received adult protection training and those spoken with demonstrated a good understanding of abuse and action to take if abuse was reported or suspected. There have been no adult protection investigations with regard to the Home or service users during the past 12 months. Dalewood Respite Care DS0000037131.V326865.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): Quality in this outcome area is good. The home is well maintained, clean and hygienic and provides a homely environment for service users. The garden is not accessible to all service users restricting activities they can participate in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the communal areas of the home was made during the visit. The internal environment of the home is well maintained and decorated throughout. Furnishings are domestic and of good quality. All radiators are covered and the majority of pipe work boxed in with the exception of a small area of pipe work that includes three exposed stop taps in the hallway. The manager agreed to contact the maintenance team that day to request that this work is undertaken as soon as possible. It was agreed that a risk assessment would be completed in the interim. Since the last inspection the bathroom on the ground floor has been refurbished and is fully accessible for service users with physical disabilities with a walk in shower area that can accommodate a wheelchair, adapted bath
Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 18 and overhead hoist. One service user told the inspector that they were pleased with the new bathroom and demonstrated how they could easily access the bathroom in their wheelchair. The kitchen has a low worktop area which the service user told the inspector they found to be a suitable height for them to prepare a meal or eat their breakfast or lunch. The home has a separate laundry room with washing and drying facilities. Service users are supported to do their washing if they want to. All service users have been provided with individual laundry baskets during their respite stay. There are hand-washing facilities in the kitchen, laundry room, bathrooms and toilets. There are plans to decorate some communal areas of the Home and service users’ bedrooms in the next month. The manager indicated that there have been no recent visits from the Fire Service or, Environmental Health Department. The property services department of Hampshire County Council undertakes routine maintenance for the Home. During the tour of the garden the inspector was accompanied by the service user who uses a wheelchair to enable them to move around the Home and garden. It was evident and the service user was unhappy that they could not access all areas of the garden ;only a small patio at the side of the Home or another small patio area at the rear .The service user said “ I would like a pathway from one paving area to the other like I have at home so I can join in all activities”. This was discussed with the manager who indicated that this would be welcomed particularly as they have 15 service users using the service and who are wheelchair users. Dalewood Respite Care DS0000037131.V326865.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): Standards 32,34 and 35 were inspected on this occasion. Quality in this outcome area is good. The home has good systems to protect service users and meet their needs through the staff training programme and recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is currently eleven permanent support staff employed in the Home which includes 3 seniors, one temporary staff member, one administrator and the Registered Manager Mrs Beech. There have been no new staff employed since the last inspection with the manager and staff indicating that there is “a good team spirit team here”. All staff are encouraged and supported to undertake NVQ (National Vocational Qualifications) training with three having achieved NVQ level 3 one NVQ Level 2 and one undertaking NVQ Level 3.The manager further indicated that all staff have undertaken the LDAF (Learning Disability Award Framework). From discussions held with staff and files viewed it was evident that staff have a wealth of experience in working alongside service users with a learning disability and were observed interacting positively and providing support for the individual in the Home throughout the visit. The member of staff on duty further demonstrated during a discussion that they had a good understanding
Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 20 of their role and responsibilities and issues relating to service users. Through observation and discussion with one service user with whom the inspector spent time with they indicated that staff did a good job of supporting them. Staff records were viewed in relation to two members of staff and recruitment procedures had been appropriately undertaken and recorded. These records included proof of Criminal Records Bureau (CRB) and POVA (Protection of Vulnerable Adults) checks, two written references for each employee, completed application forms with employment histories, rehabilitation of offenders and health reports. All staff received written terms and conditions of employment and job descriptions. There is structured induction training for staff linked to NVQ awards and a further training programme to ensure that staff have the skills to meet service users needs. Records showed that staff had a range of training including health and safety, first aid, manual handling, fire safety, infection control, Person centred Planning, makaton, autism, cultural awareness and equalities and diversity. Further training is planned for this year of which staff spoken to indicated was welcomed and enabled them to feel valued and to build on their skills and experiences. Training certificates were held on individual staff members’ files. Agency staff do not commence work until they have undertaken an induction into the Home and are required to provide evidence of mandatory training undertaken with the agency. Supervision records were seen on file and staff confirmed that the registered manager is approachable and extremely supportive. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 21 Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 were inspected on this occasion. Quality in this outcome area is excellent. The home is run by a competent manager who takes action to promote the health, safety and welfare of service users and staff and uses feedback from service users and their relatives to plan improvements to the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has completed the National Vocational Qualification Level 4 in Care and Management and has undertaken a range of additional training. Mrs Beech indicated that she receives support from the senior management staff and is able to speak with them whenever he needs to. Staff spoken with said that they felt well supported by the manager, attended regular team meetings and received regular supervision. There are a number of excellent systems in place to monitor service provision which include a news letter, parent questionnaires, weekly service user
Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 23 meetings and a range of information that has been developed and produced in pictorial formats which the manager indicated has enabled all service users whatever their level of understanding to contribute to the service provision. The manager further indicated that a meeting held for parents was well attended and a number of ideas and suggestions made to the benefit of the Home. Service users are also encouraged to complete a questionnaire after each respite stay in addition to yearly questionnaires sent to all service users to gain their views and ideas for future service provision. Senior managers from the providers visit the home each month to review the service quality. Reports of these visits contain actions that are required to improve the service. The home has a fire risk assessment and regular checks are made of the fire warning system and the equipment. Staff have received fire training and were able to explain the fire evacuation procedures in the Home, as was the service user who spent some time with the inspector. Staff were also aware of risk assessments that had been compiled as to the needs of each service user in the event of the need to evacuate the Home. The gas system is serviced annually and annual tests of portable electrical appliances are completed. Assessments are completed for chemicals used in the home, which are stored in a locked cupboard. The temperatures of the fridge and freezer are taken daily and recorded. Accidents and incidents to service users and staff are recorded and reported where necessary. Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 4 X Dalewood Respite Care DS0000037131.V326865.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. Standard Regulation Requirement Timescale for action 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 Dalewood Respite Care DS0000037131.V326865.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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