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Inspection on 27/11/07 for Dalkeith Lodge

Also see our care home review for Dalkeith Lodge for more information

This inspection was carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People say that they have a relaxed and comfortable setting within which to make their home. They say that they receive all the assistance they need. They consider that the support workers are attentive and kind in their manner. People are assisted to maintain and to promote their health. Good quality meals are served. Support workers know what they are doing.

What has improved since the last inspection?

The ground floor shower room has been completely refurbished. The central heating service has been extended into what was previously a cold spot.The Registered Provider has checked that some of the members of staff know how to reliably follow the Service`s fire safety procedure.

What the care home could do better:

There is an omission in the written plan of care for one of the people in residence. There are a number of defects in the first floor bathroom. More generally around the accommodation, areas of the decoration are worn and unsightly. The quality assurance system is not sufficiently developed. The periodic check of the electrical wiring installation is overdue.

CARE HOME ADULTS 18-65 Dalkeith Lodge 41 Mickleburgh Hill Herne Bay Kent CT6 6DT Lead Inspector Mark Hemmings Key Unannounced Inspection 27th November 2007 09:00 Dalkeith Lodge DS0000023389.V350528.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 Dalkeith Lodge DS0000023389.V350528.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. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dalkeith Lodge Address 41 Mickleburgh Hill Herne Bay Kent CT6 6DT 01227 362820 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) sheorattan@aol.com Mrs Baswantee Sheo-Rattan Mrs Baswantee Shep-Rattan Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One Service User whose date of birth is 14/09/1933. Date of last inspection 22nd December 2006 Brief Description of the Service: Dalkeith Lodge (the Service) is registered to provide accommodation and personal care for eight adults who have a learning disability. The accommodation is arranged on two floors. When full, there is provision for two of the bedrooms to be shared by two service users each. All of the remaining bedrooms are for single occupancy. All of the bedrooms have a private wash hand basin. The property is detached and is located in a residential street. It is within normal walking distance of Herne Bay town centre. There is some private off-road car parking. There is an attractive garden to the rear of the property. People who are interested in finding out about the Service, can read the Service Users’ Guide and the Statement of Purpose. These are available from the Registered Provider. Between them, they give a lot of information about the facilities and services that are provided in the Service. The weekly fee for residence in Dalkeith Lodge is £376.00 to £400.00. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. The Inspector arrived at the Service at 09.00 and was in the Service for four and a half hours. It was a thorough look at how well the Service is doing. It took into account detailed information provided by the Service’s owner or manager and any information that CSCI has received about the Service since the last inspection. There are three Required Developments at the end of this Report. What the service does well: What has improved since the last inspection? The ground floor shower room has been completely refurbished. The central heating service has been extended into what was previously a cold spot. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 6 The Registered Provider has checked that some of the members of staff know how to reliably follow the Service’s fire safety procedure. 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. Dalkeith Lodge DS0000023389.V350528.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 Dalkeith Lodge DS0000023389.V350528.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the Service. There are arrangements to ensure that prospective people who might want to move in will have their needs assessed and their wishes acknowledged. EVIDENCE: There have not been any new admissions to the Service for some time. None are planned in the foreseeable future. However, there are arrangements in place to respond to new admissions. The Registered Provider says that in consultation with the person concerned, she will complete an assessment of their needs for support. This will be done so that she can be sure that these needs can be met in the Service. Also, it will enable the wishes of the person to be acknowledged and respected. The Registered Provider says that she will also consult with other people such as doctors, care managers (social workers) and family members. This will be done so that relevant background information can be acquired. The Registered Provider is aware of the need to ensure that all of the support workers are informed about the needs of a new person. This is done so that Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 9 their needs for assistance can be met in a reliable and consistent manner from the start. Dalkeith Lodge DS0000023389.V350528.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): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the Service. The health and personal care that people receive, is based upon their individual needs. People are actively involved in making decisions about things that affect them. Sensible provision is made to promote an independent lifestyle. EVIDENCE: The people who use the Service say that the support workers offer them all the assistance they need and that this is provided in a reliable and consistent manner. There is a written plan of support for each person. These are important documents. This is because they form one of the means by which people who use the Service can be informed about and can agree to the assistance they will receive. Also, the plans are a source of reference Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 11 information for the support workers. There is an omission in one of the plans in that a particular aspect of the assistance provided is not described in adequate detail. There is a Required Development in relation to this matter at the end of this Report. People are assisted to make decisions about their own lives. This means that they can be as independent as they want to be. When extra help is required, this is delivered in an appropriate manner. For example, people are assisted to manage aspects of the personal spending monies. This is done in a way that maximises the involvement of the person concerned so that support workers do not take over when it is not necessary. Sensible arrangements are in place to help the people in residence to lead normal lives, without entertaining unreasonable risks to their wellbeing. This is not done in an intrusive manner and the result is not overly cautious. Dalkeith Lodge DS0000023389.V350528.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): Standards 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the Service. The people who use the Service can choose to become involved in a range of social and vocational activities. They are helped to keep in touch with members of their families. Good quality meals are served. EVIDENCE: The people who use the Service are free to choose what to do each day. The pace of daily life is relaxed. There are no unnecessary rules or routines to disrupt the experience of a normal domestic setting. The people in residence say that their time is adequately occupied. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 13 The people who use the Service have individual weekly calendars of activities that they can undertake. These calendars show that considerable care has been given to selecting activities that are appropriate for the person concerned. The Registered Provider is going to continue to review the range of opportunities provided for the people in residence. She recognises that this will require careful consideration of the things that are most likely to engage the interests of the people concerned. The people who use the Service are assisted to keep in touch with family and friends. This is very important because most of the people in residence have special communication needs and so need a good deal of help to maintain contacts. People can receive visitors at any reasonable hour. They can meet with their visitors in the privacy of their bedroom if they wish to do so. The Registered Provider is going to find out if one of the people in residence wants to meet with an old friend who lives nearby. This is going to be done by 1 January 2008. The Registered Provider in consultation with the people in residence consults with their relatives. This is important because it keeps families in touch with how things are going and because it helps to promote their involvement. The people who use the Service say that they receive good quality meals and they always have enough to eat. The menu indicates that a range of dishes is served. The Registered Provider says that careful attention is given to ensuring that the people in residence are offered the chance to have a balanced diet that is likely to help with the promotion of good health. The people in residence are actively consulted about what dishes to have prepared and they are asked to suggest alterations and developments to the menu. The Registered Provider is aware of the need to accommodate special diets that may be necessary for particular health reasons. Dalkeith Lodge DS0000023389.V350528.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the Service. People are supported in accordance with their wishes. They are assisted to promote their physical health. Suitable arrangements are in place to manage medication. EVIDENCE: The people who use the Service say that the support workers are kind and considerate. They are relaxed in the company of the support workers. There is a family atmosphere. Support workers ensure that personal care is provided in private when appropriate. The people in residence are assisted to dress in the manner of their choice. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 15 The people who use the Service are assisted to maintain their physical health. Support workers keep a tactful eye open, so that medical attention is sought promptly should the need arise. Since the last inspection visit, family practitioners and various other medical resources have been involved in a timely manner to support the care provided in the Service. The people in residence are also assisted to promote their health. This is done by encouraging them to take steps such as watching their weight and attending to their dental hygiene. Suitable arrangements are in place to enable medication to be managed appropriately. This includes a stock management system that ensures that the medicines supplied to the Service are correct. Once in the Service, medicines are stored in a secure and orderly manner. There is a written procedure to guide support workers when dispensing medicines. Support workers are careful to ensure that the people in residence take medicines in the manner intended by their doctors. Dalkeith Lodge DS0000023389.V350528.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the Service. There is an effective system for dealing with complaints. The wellbeing of the people who use the Service is safeguarded. EVIDENCE: The Registered Provider is aware of the need to ensure that complaints about the Service are investigated thoroughly and resolved promptly. Since the last inspection, neither the Registered Provider nor the Commission had received any formal complaints relating to the Service. There is a written procedure that explains how people can raise a concern about the Service. There is also a more user-friendly version that does not rely so much on the written word. Support workers take the time necessary to liaise with each person so that they feel confident about raising any concerns should they have any. The people who use the Service say that they can approach members of staff if there is something on their mind. There is a written procedure that is intended to guide support workers about what constitutes good care practice and about what to do if they are concerned about someone’s wellbeing. The support workers are aware of the need to be Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 17 alert to instances in which the well being of people who use the Service might become jeopardised. The people in residence say or indicate that they feel safe living in Dalkeith Lodge. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 18 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): Standards 24, 25, 27 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the Service. The accommodation enables people to live in a generally well-maintained and comfortable environment, that promotes their independence. A number of defects detract from the overall standard achieved. EVIDENCE: The people in residence say that they are comfortable living in their home. In general, the accommodation is welcoming and pleasant. It has a lived-in feeling to it. Since the last inspection, the ground floor shower room has been completely refurbished. This work has very considerably improved the presentation and the usefulness of this facility. A similar approach will need to be adopted in Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 19 relation to the first floor bathroom. Here, a number of defects make the room look tatty and uninviting. The Registered Provider says that she intends to address this matter during the course of 2008. There are some other defects around the place. These are largely to do with things such as damaged wall finishes and chipped paintwork. The Registered Provider will need to attend to these matters once the refurbishment of the bathroom has been completed. The premises are fitted with a modern automated fire detection system. This meets the requirements of the Kent Fire and Rescue Service. The Registered Provider has assessed how best to avoid the occurrence of a fire safety emergency in the Service. This exercise shows that there are no appreciable hazards that require special management. The kitchen is clean and well organised. Sensible food handling and general hygiene arrangements are in place. These arrangements have been found to be satisfactory by the local Department of Environmental Health. The laundry is adequately equipped. The Service complies with regulations that are designed to ensure that used water does not leak back from appliances such as the washing machine into the main drinking water supply. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 20 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 33, 34, and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the Service. The current staffing levels meet the minimum requirements only. Support workers are appropriate people. They know what they are doing. EVIDENCE: There is at least one support worker on duty in the Service. People say that they receive all the assistance they need. There is not much capacity for people to have one to one assistance. The Registered Provider needs to keep this matter under careful review. The Registered Provider completes various security checks for prospective support workers. This is done to ensure that only suitable people are trusted to have unsupervised access to the people in residence who may be vulnerable. New support workers receive introductory training. This is designed to ensure that they have the basic knowledge and skills they need in order to be able to work without direct supervision. This is important because the quality of care delivered in the Service, depends largely upon the adequacy of the Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 21 competencies support workers have to hand. The Registered Provider is going to review aspects of the way in which the introductory training is organised and recorded. This is being done to ensure that all of the required subjects are indeed being suitably covered. She will be doing this exercise using a national model that the Commission considers to be a guide to good management practice. In addition to the introductory training, existing support workers undertake a number of additional training courses. These are selected to ensure that they are directly relevant to the support delivered in the Service. There is some uncertainty about who has done what courses and about the arrangements to be used to address any omissions. Given this, the Registered Provider is going to complete an in-house review of the existing support workers’ competencies using the national model noted above. This exercise is going to be undertaken by 1 July 2008. The support workers have a suitably detailed knowledge of the personal requirements of each of the people in residence. They have the skills they need to deliver the assistance described in the individual plans of care. Dalkeith Lodge DS0000023389.V350528.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the Service. The Service is suitably managed. There is only a basic quality assurance system. Various measures are in place to safeguard health and safety. EVIDENCE: The Registered Provider is qualified and she oversees a number of arrangements that are designed to ensure the efficient running of the Service. One of these involves ensuring that support workers are kept up to date with how things are going for each of the people in residence. This includes having Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 23 regular meetings at the beginning and at the end of each shift. Also, it includes the maintenance of diary records that show how things are going on a daily basis. The people who use the Service are invited to comment informally about how things are going. While this is very important, there also needs to be a more organised system to enable the people in residence and other stakeholders to contribute their views about the Service. The Registered Provider will need to give this matter careful attention in the manner described in the relevant Required Development at the end of this Report. The service documents confirm that items of equipment in use in the Service remain in good working order. For example, gas fired appliances and portable electrical appliances. The periodic check that has to be completed of the electrical wiring installation is overdue. There is a Required Development in relation to this matter at the end of this Report. The continued operation of the fire detection and fire management system is checked regularly. There are regular fire drills. There is an additional system that should check regularly that all members of staff know how to operate reliably the Service’s fire safety procedure. This has become a little overdue. The Registered Provider is going to put this right by 1 December 2007. The Registered Provider checks the building and the accommodation to ensure that potential environmental hazards to health and safety are addressed. She says that there are no hazards currently in the Service that are waiting to be addressed. Substances such as bleaches and other cleaning fluids are stored safely when not in use. Dalkeith Lodge DS0000023389.V350528.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 2 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 2 25 3 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12 Requirement The Registered Provider should address an omission in the written plan of care for Person A. The Registered Provider should develop a suitable quality assurance system. This should ensure that relevant stakeholders are invited to comment on the Service. Also, that they are informed about what is to be done in order to respond to any suggested improvements. The Registered Provider should ensure that the electrical wiring installation is inspected in accordance with the relevant British Standard. Timescale for action 01/01/08 2. YA39 12 01/04/08 3. YA42 23 01/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 26 No. Refer to Standard Good Practice Recommendations Dalkeith Lodge DS0000023389.V350528.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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