CARE HOME ADULTS 18-65
Follybridge House Bulbourne Road Tring Herts HP23 5UG Lead Inspector
Barbara Mulligan Unannounced Inspection 7th February 2006 10:15 Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 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 Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Follybridge House Address Bulbourne Road Tring Herts HP23 5UG 01442 828285 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) Turning Point Limited Mr Alan Bruce Wilson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 6 residents with a learning disability and mental illness Date of last inspection 6th October 2005 Brief Description of the Service: Follybridge House is situated in a quiet rural area, backing on to a nature reserve accessible to Service Users. The home has large, attractive and wellmaintained grounds, which contain a sensory garden, a trampoline, and swings. The home is part of the charitable organisation Turning Point, which provides residential accommodation for people with learning disabilities and mental health problems. Follybridge House accommodates up to six male Service Users with behavioural problems and learning and communication difficulties. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the inspection summary of an unannounced inspection carried out at Follybridge House on Tuesday 7th February 2006 at 10:15am by Inspector Ms. Barbara Mulligan. The inspection consisted of looking at a number of records and discussion with the registered manager Alan Wilson At the time of the visit one service users was at home and the remaining service users were at their chosen day care activities. At the time of the visit one service users was at home and the remaining service users were at their chosen day care activities. The inspector assessed fifteen of the National Minimum Standards for Younger Adults with twelve of these fully met and four almost met. As a result of the inspection the home has received five requirements. The home are to be commended on the Service Users Guide which they have recently completed. The inspector would like to thank the service users, the staff team and the registered manager for their cooperation during the inspection. What the service does well:
The Service Users Guide is excellent. This is in pictorial form and is suitable for service users who are unable to read. The home is to be commended on the Service Users Guide. The home provides a very pleasant and comfortable environment in which service users can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Service users are given opportunities to make decisions about their lives, with assistance as needed. The home has regular service users meetings and service users relatives/representatives are consulted on aspects of the home. Care planning documentation is of a good standard and each service user’s plan contains a detailed action plan. There is an effective complaints procedure with all complaints and concerns being acted upon promptly within stated time scales. There is a motivated and established staff team that consists of care/support staff. Medication is well managed in the home with relevant procedures in place for the administration of medicines. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 6 There is good support for the home by the provider organisation, with effective monitoring and quality assurance systems in place. Recruitment procedures are rigorous with all necessary security checks in place to ensure the protection of Service Users. Risk assessments are in place that both protect the Service User from harm and ensure they are able to maintain and develop their independence. Families are welcomed to the home with Service Users supported to maintain their links with families and friends. What has improved since the last inspection? What they could do better:
There are two sets of policies and procedures, one is by Hertfordshire Learning Disabilities Service and the other set are by Turning Point. The policies by Hertfordshire Learning Disabilities have not been reviewed for an unacceptably long period of time and many contain outdated information. The policies by Turning Point are more up to date and reviewed regularly. During the inspection it was evident that both sets are in use in the home. The
Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 7 registered manager needs to ensure that all policies by the home are up to date, comply with current legislation and recognised professional standards. This is a requirement of the report. Following the previous unannounced inspection a requirement was issued for the Service Users Guide and Statement of Purpose to be completed. The Service Users Guide has now been finished and the home is required to complete the Statement of Purpose. This will be a requirement of the report. While looking at policies and procedures for The Protection of Vulnerable Adults it was evident that the homes copy of the local authority Adult Protection procedure was missing. The registered manager is required to obtain another copy as soon as possible and is a requirement of the report. All staff receive training about Adult Abuse and this forms part of their induction. However following the induction there is no system in place to ensure staff receive regular up to date training and there is evidence to show that several staff need to update their POVA training. This is a requirement of the report. and is a requirement of the report. The kitchen is small and not easily accessible to service users, which does not enable service users to take an active role when preparing and cooking meals. The ovens are old, in need of repair and very grubby. The housing for the ovens is wood and is in a state of disrepair. It is a requirement of the report that the ovens and the housing for the ovens is replaced. Serious consideration needs to be given to making the kitchen more accessible to service users, allowing them to take a more active part in the preparation of meals. 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. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 8 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 Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. The Statement of Purpose does not adequately provide potential service users with details of the service and needs to be reviewed and updated as necessary. The Service Users Guide is particularly user friendly with a pictorial guide to provide service users with details of the services that the home provides. Service users needs are thoroughly assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. Service users receive care services from staff who have the skills and competencies to meet their care needs. The opportunity to visit the home prior to admission is an integral part of the admission process, which means that service users are orientated to the environment and have met and are familiar with staff and other service users beforehand. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 10 EVIDENCE: Following the previous unannounced inspection on 6th October 2006 a requirement was made that the Statement of Purpose and Service Users guide be updated to reflect all areas of schedule 1 and standard 1.2. It is pleasing to see that the Service Users Guide has been reviewed and the home have included pictorial guidance to make it more user friendly. This document is very detailed and comprehensive and is to be commended. At the time of the visit there was only one copy available and the inspector requests that a copy be sent to the Commission. The home now need to complete their Statement of Purpose and this was discussed with the registered manager. This will be a requirement of the report. The home has an admission file and this contains an admission procedure by Turning Point called “ Is this the home for you?” and the initial assessment tool. This is detailed and covers the necessary information detailed in standard 2. Hertfordshire County Council sets the criteria for admission to the home. However, since the home opened, there have been no further admissions. If there were an admission to the home, the registered manager would be responsible for undertaking and completing the initial assessment. The policy/procedure for admission to the home states that “ visits will be organised, increased in length and frequency and come to include meals, overnight stays and weekend visits”. If a potential service user is admitted to the home a review will be undertaken following the first six months. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10. Service users make decisions about their lives, with assistance and communication support, that allows them to influence their lifestyle and how the home is run. Support staff enable service users to make decisions in relation to their own lives, providing information, assistance and support to maintain their independence. Personal information is handled appropriately ensuring that personal confidences are respected. EVIDENCE:
Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 12 Service users are given opportunities to make decisions about their lives, with assistance as needed. This includes help to make decisions regarding their choice of activity, daily routines, menu planning and preferred daily routines. Service users are offered opportunities to participate in the day-to-day running of the home as far as they are able to. Meetings with service users rarely take place and it is recommended that regular meetings are implemented and a record kept of these meetings. The home attempts to involve the service users with key decisions about the running of the home, although communication difficulties with service users can make this a complex process. There is little evidence that service users are provided with accessible, understandable and up to date information in a suitable format regarding policies/procedures activities and services. This is a recommendation of the report. Service users each have a bank account and their benefits are paid into their own individual accounts. Each service user has a cheque book and if money is required to be withdrawn from the service users account, the registered manager and the service manager will sign a cheque. There are no service users living in the home who are able to manage their own finances. Each service user has their own lockable tin which the registered manager and service users key-workers access. There is evidence that an annual audit is undertaken. Following the last audit it was recommended that service users monies are formally handed over at shift changes, however this has not been implemented. The home has an advocate but the registered manager said she has not been present at the home for a long period of time. There are no service users participating in any local independent self-advocacy groups at the time of the visit. Guidelines regarding missing persons and a range of individual risk assessments are in place and these are detailed and informative. Service users records observed are accurate, secure and confidential. Training in confidentiality is covered during staff induction. There is a Hertfordshire County Council Learning Disabilities policy regarding confidentiality dated 1995. This is outdated and refers to the UKCC. There is more up to date information in a Turning Point Operational Policy Manual regarding confidentiality and it is not clear which policy staff refer to if they require information. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The home promotes ‘flexible’ visiting, which enables service users to maintain contact with their friends and family. EVIDENCE: Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 14 Families and friends are welcomed into the home and are involved in daily routines and activities if service users wish. Service users can choose whom they see and can see visitors in their own rooms, in private, if they wish. There are no restrictions about family and friends visiting. Staff assist service users to maintain contact with family and friends. Staff knocking on bedroom, toilet and bathroom doors maintain the privacy of individuals. If service users expressed a wish to have a key to their own bedrooms then this will be facilitated. Staff open mail with the service users, as they are unable to do so themselves and the mail is read to them. Preferred term of address are used for service users and this is recorded in the care plans. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. Medication procedures within the home are robust and staff training good, which ensures that service users are protected by the systems in place. EVIDENCE: Following the previous unannounced inspection a required was issued for the Homes Medication policy to be up-dated. It is pleasing to see that this has been completed and is detailed and reflects current guidelines. The Home has robust medication procedures in place to ensure the safety of Service Users. Suitably trained staff administers all medication. Controlled medicines have been used recently in the home and there is a controlled drugs book where these are recorded. All controlled medication is appropriately stored in a lockable facility. The Manager usually completes returns (or Deputy Manager) with signatures in place; the Pharmacy will then collect all returns from the Home. In addition to the prescribed medication used in the Home a homely remedies book is also in place with all administrations recorded. The Home also holds such things as TCP, plasters, paracetamol, euroax lotion and other creams for staff usage, these are stored in a tub separate from Service User medication. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Vulnerable adults are protected through a range of policies and procedures, which means that their intrinsic human rights are protected. However, POVA training for care staff needs to be updated on a regular basis. EVIDENCE: Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 17 The home use the Hertfordshire Adult Protection procedure in conjunction with Turning Point policies/procedures for the Protection of Vulnerable adults. However, the Hertfordshire Adult Protection procedure was missing on the day of the inspection and the registered manager is required to obtain another copy as soon as possible. There is a Hertfordshire Learning Disabilities Services policy/procedure regarding Adult Protection. However, this is dated 1999 and contains a lot of outdated information. Turning Point has a more up to date policy contained in a Human Resources Manual dated 2002. Again it is unclear which policy/procedure staff refer to if they require information. All staff receive training about Adult Abuse and this forms part of their induction. However following the induction there is no system in place to ensure staff receive regular up to date training. There is evidence to show that several staff need to update their POVA training and is a requirement of the report. There is a Whistle Blowing policy and care staff undertake training in Challenging Behaviour The homes policies regarding service users money and financial affairs ensure service users access to their money, valuables and safe storage is safe guarded. There is a gifts procedure that provides staff with guidelines about receiving personal gifts from service users. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The standard of the environment within this home is good, providing service users with an attractive and homely place to live. However, the kitchen needs to have the ovens and the housing of the ovens replaced. EVIDENCE: The kitchen is small and not easily accessible to service users, which does not enable service users to take an active role when preparing and cooking meals. The registered manager stated that if service users are helping to prepare meals, the food is taken out of the kitchen to an area where there is more room. The ovens are old, in need of repair and very grubby. The housing for the ovens is wood and is in a state of disrepair. It is a requirement of the report that the ovens and the housing for the ovens is replaced. Serious consideration needs to be given to making the kitchen more accessible to service users, allowing them to take a more active part in the preparation of meals. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 33 Service users benefit from clarity of staff roles and responsibilities. ensuring that their care and support needs are appropriately and effectively met. Service users benefit from an effective staff team, with sufficient numbers and skills to support service users needs at all times. EVIDENCE: Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 20 Staff have the skills and experience necessary for the tasks they are expected to do. The care staff are able to communicate with the service users at the home and have a good understanding of individuals communication needs. New staff undertake an induction to the home and the organisation. This covers areas regarding understanding physical and verbal aggression and self harm, cultural and religious needs and the role of the multi-disciplinary team. Further training by staff includes First Aid, Basic Food Hygiene, Moving and Handling and Fire Awareness. Two staff members have completed NVQ level 2 and the registered manager is in the process of completing his NVQ level 4 training. The use of agency staff is kept to a minimum. The numbers and skill mix of the staff team ensure that uninterrupted work with individuals can be carried out, the administration, organisation and day to day running of the home are carried out effectively and also allows for the management of emergencies. There are twelve care staff in total and the rotas demonstrate that there is three care staff on duty in the morning and the afternoon. At night there is one waking and one sleep-in staff. Staff meetings occur approx six weekly. There are recorded minutes of the staff meetings and there is evidence that issues raised in the staff meetings are actioned. At the time of the inspection there were no staff under the age of 18 years working in the home and there are no volunteers. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 40 and 43, The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. There are two sets of policies/procedures, one from Turning Point and the other from Hertfordshire County Council. Many of the policies from Hertfordshire County Council contain outdated information that does not ensure the rights and best interests of service users are protected. The overall management of the home ensures the effectiveness, financial viability and accountability of the home. EVIDENCE: Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 22 The registered manager of Follybridge has been in post as manager for five years. He is a qualified nurse for people with learning disabilities and previous experience has included working in a hospital and with the probation service. Further training undertaken by the registered manager has included LDAF, Epilepsy training, managing absence, recruitment and selection and supervision and appraisal. The registered manager has the overall responsibility for ensuring the homes written aims and objectives are achieved, the homes budget is properly managed, policies and procedures are implemented, certificate’s are displayed and that the home complies with the Care Standards Regulations. There are two sets of policies and procedures, one is from Hertfordshire Learning Disabilities Service and the other is from Turning Point. The policies from Hertfordshire Learning Disabilities service are very dated, have not been reviewed and contain outdated information. The policies from Turning Point are more up to date and relevant. It is a confusing practise to have two differing sets of policies, particularly when one set is outdated. This could lead to staff following wrong procedures. The home need to ensure that there is one set of relevant and up to policies and procedures and is a requirement of the report. There are insurance certificates on display in the home. The organisations business and financial plan was not available for inspection. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 X 3 LIFESTYLES Standard No Score 11 x 12 X 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 X X 3 X X 2 X X 3 Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation Schedule 1. Requirement The registered manager is required to ensure that the Statement of Purpose be updated to reflect all areas of schedule 1. The registered manager is required to ensure that a copy of the local authority Adult Protection procedure is obtained. The registered manager is required to ensure that all staff receive regular POVA training. The registered provider is required to ensure the two ovens and the oven housing is replaced. The registered manager is required to ensure that there is one set of relevant and up to policies and procedures. Timescale for action 30/03/06 2 YA 23 13(6) 14/03/06 3 4 YA 23 YA 24 13(6) 23(2) 30/07/06 30/12/06 5 YA40 12(1)(a) 30/04/06 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 Good Practice Recommendations
DS0000022972.V282716.R01.S.doc Version 5.1 Page 25 Follybridge House 1. Standard YA8 It is recommended that service users are provided with comprehensive, accessible, understandable and up to date information, in suitable formats, about its policies, procedures, activities and services. Follybridge House DS0000022972.V282716.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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