CARE HOMES FOR OLDER PEOPLE
Hatfield Haven Stortford Road Hatfield Heath Bishops Stortford CM22 7DL Lead Inspector
Sharon Thomas Unannounced 13th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Hatfield Haven Address Stortford Road, Hatfield Heath, Bishops Stortford, Essex, CM22 7DL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01279 730043 01279 730043 Hatfield Haven Ltd Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (OP) 18 Both of places Dementia - over 65 years of age (DE(E)) 18 Both Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 18 persons) 2 Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 18 persons) 3 The total number of service users accommodated in the home must not exceed 18 pesons 4 Service users must not be admitted to the home under the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 Date of last inspection 22nd October 2004 Brief Description of the Service: Hatfield Haven is a large detached house. The home is located on the edge of the village of Hatfield Heath that provides access to public transport and shopping facilities. The newly appointed manager Lisa West has worked at Hatfield Haven for the past four years.The home is registered to provide residential accommodation for 18 older people (over the age of 65, with dementia), with low to high dependency needs. The home provides personal care to those service users who are assessed as requiring support in this area. Hatfield Haven provides individually tailored care and aims to meet the physical, social and emotional needs of the individuals who live there in a warm and homely environment. The home has bedrooms located on both the ground and first floor of the premises; the upper floor is accessible through the passenger lift. The home’s grounds are accessible to both the service users and their visitors. The home is well equipped to meet the needs of the current service user group and provides aids and adaptations to assist service users with limited mobility.The home benefits from a well-trained and sensitive staff group who had a sound knowledge of the service users and their needs. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on one day in April 2005, over 6 hours. Fifteen of the thirty National Minimum Standards were inspected: four were met, five were nearly met and six were not met. The inspection was carried out as the Commission for Social Care Inspection (CSCI) had received a number of complaints regarding the service. The complaints received related to the quality of care provided in the home. For the purpose of this report the individuals spoken with on the day stated that they would prefer to be referred to as residents. A partial tour of the premises was completed, care and staff records, and documentation relating to Health & Safety, were inspected on the day. During the inspection seven residents, two relatives and four members of staff were spoken to. The proprietor and manager were available for the inspection and the level of co-operation was welcomed. What the service does well:
The residents living in Hatfield Haven benefited from an established and knowledgeable staff group who gave sensitive and professional care. The staff had a well formed knowledge regarding the needs of the individual residents. This was seen in the positive relationships that had formed between the residents and staff. The majority of residents spoken with on the day stated that the staff group were “kind and caring” and one resident in particular stated that “ the staff could not be better, or more helpful”. The residents said that they felt valued by the staff and that they felt that their daily needs were being provided. The routines in the home were as flexible as possible and are changed to the meet the varying needs of the residents. Relatives and visitors are welcomed into the home and residents felt that the home encouraged their relationships. Some of the activities provided were specifically designed to provide stimulation for residents with dementia. Residents were observed enjoying big band music and a classic DVD. The environment in the home was considered safe and well maintained. The home had a warm and homely feeling. The largest communal lounge area and much of the ground floor hallway and corridor areas had recently been redecorated in a soothing, calming colour. The residents spoken with on the day reported that they “felt safe, warm and comfortable”.
Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
The information held on files about residents and assessments regarding risk need to be improved to ensure that the care being given by staff is safe and necessary. The information should identify all aspects of the care needed by individuals and to give clear guidance to staff to enable them to deliver appropriate care. The home’s complaint system requires improvement so that residents and relatives are provided with information as to how and who to make a complaint to. A choice of main meal must be offered and the chef should be aware individual residents’ nutritional needs to make sure that specific dietary requirements are provided.
Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 7 The home’s staff recruitment system required improvement to ensure that newly recruited staff have completed all of the necessary recruitment checks. The home’s policies and procedures needed development to ensure information for residents and staff is updated and appropriate. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, & 6. The home did not provide residents with an up to date Statement of Purpose and Service User Guide. Therefore prospective residents and their representatives were unable to make an informed choice. The home had an effective pre-admission system in place that ensured that every prospective resident had their physical, mental, emotional and social needs assessed. Hatfield Haven did not provide intermediate care. EVIDENCE: The draft format of the home’s new Statement of Purpose and Service User Guide were examined and needed further amendment to include all of the information required under the National Minimum Standards. When completed the home must ensure that each resident receives a copy. The pre-admission assessment was undertaken by the manager, to establish the needs of the individual. The care plans examined indicated that residents or relatives were involved in the assessment of need. The home’s preHatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 10 admission assessment document was comprehensive and identified all aspects of the individual’s care needs. One resident spoken with confirmed that prior to their recent admission their family had been fully involved with all decision making. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8. Overall the health care needs of the residents are being promoted and maintained in the home. The home’s care planning systems remain insufficient. Evidence collected reflected that the residents care needs were not identified, planned for and monitored in an appropriate manner. The shortfalls identified below have the potential of placing resident at risk. EVIDENCE: The three care plans sampled did not accurately reflect the care needs of the residents. The care plans did not contain detailed information regarding the physical, mental, emotional and social needs of the residents. One particular care plan did not fully detail the health needs of the resident. The care plans lacked information regarding the action to address the identified need and did not contain information regarding the outcome of care delivery. One service user spoke to the inspector of their social, religious and spiritual needs, however these issues were not found within their individual care plan. Risk assessments were not completed to identify all aspects of risk. When questioned residents reported that changes to their care were often made without their consultation. When examined, the care plans provided no evidence to suggest that residents were involved in the care plan process. The
Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 12 records of daily care needs did not accurately identify the care provided and some entries were negative in description. Although the care plans identified some basic healthcare needs. The care plan of one resident who had a history of falls as identified in the Social Service assessment, had not had that information transferred to the daily plan of care. One of the complaints received and investigated by the CSCI alleged that the resident’s healthcare needs were not being met. On inspection of the resident’s care plan it was found that the health needs that were recorded were not accurate, nor updated. Residents were at risk of not having some of these needs met due to a lack of information on individual care plans. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 & 15. The home provided the residents with a variety and choices with regard to their daily lives. Their expectations and preferences with regard to lifestyle are well met, and the capacity of individual residents to make choices is central to the care provided in the home. The residents were provided with a wholesome and appetising meal. The home did not enable residents to exercise choice over what they ate. Records relating to specialist nutritional needs of individual residents were not made available to kitchen staff, and the lack of information may place residents at risk. EVIDENCE: Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 14 The manager confirmed that the home does not act as appointee for any of the residents living in the home. The residents spoken with on the day were aware of the local advocacy service, one resident reported that they “knew that there was someone to speak to”. However this information was not displayed in the home. Arrangements for residents to bring in possessions were discussed prior to admission, but records of possessions were not available. One resident reported that their room was “full of ornaments and paintings from their home”. The care plans examined indicated personal preferences in terms of food, clothes and other daily choices. The service users spoken with on the day stated that they felt that their rights and choices were upheld and respected. One service user confirmed that they would not be pressured by the staff to undertake an activity that they were not prepared to participate in. The residents confirmed that the meals in the home were “appetising and tasty”. The home did not offer a choice of main meal. The home did not display a menu for the residents. This was discussed with residents who confirmed that they would like a choice of meal, and that the alternative provided in the home was not sufficient or attractive. The agency chef was available for comment and it was noted that the information regarding the specific nutritional needs (diabetic and soft diet) were not available in the kitchen. The home had sufficient stocks of fresh food, however the home did not provide any stocks of frozen vegetables for use as a replacement in an emergency. The issue regarding the lack of nutritional information could place residents at risk. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 &18. The home did not operate a clear and substantial policy and procedure with regard to the complaints process. The home had clear and comprehensive systems in place that ensured the ongoing protection and safety of the residents. EVIDENCE: The home did not have an operational complaints policy and procedure. The complaints log was inspected and new entries were recorded. One formal complaint had been received by the CSCI regarding poor care practice and this complaint was upheld after investigation. The residents in the home confirmed that they did not know of a complaint process, however they were all able to report that they felt confident to go to the management with their concerns. One relative spoken with on the day reported that they had made a number of complaints that had not been addressed, and felt that “complaints were not taken seriously”. The manager, proprietor and staff confirmed that training in the Protection of Vulnerable Adults was provided in the home however, the home’s training programme was not available, nor were training records to confirm this. The home had a comprehensive policy, procedure and guidance on the Protection of Vulnerable Adults (POVA). On discussion with the manager it was clear that she had an in-depth knowledge regarding this issue and the POVA referral procedure. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 25. The home provided a safe and well maintained environment to residents. Overall the home was clean, warm and homely in nature. EVIDENCE: The home had recently employed a full time handyman who will maintain the home and it’s large grounds. Previously the absence of a handyman had resulted in basic maintenance tasks being neglected. The home was clean, bright and airey, and had a homely feel. On tour of the premises there were a number of areas that had offensive odour and one relative reported that the odour was causing distress for residents and other visitors. Recent extensive re-decoration had given the home a calming atmosphere. Bedrooms were personalised and residents commented throughout the inspection that the home was well maintained, comfortable and clean. The home had fully guarded radiators that reduced the risk of burns to residents. The home did not maintain hot water temperatures for baths and this places the residents at risk
Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 17 of scalding. Environmental Health Officer inspection reports were not available for inspection. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 & 30 The home provided the residents with a well trained and knowledgeable staff group. Staff were provided with training appropriate to the needs of the current resident group. The stable staff group ensured that residents received consistent care delivery. The recruitment procedures in the home was not robust and did not provide the safeguards to ensure that appropriate staff were employed. EVIDENCE: Although the staffing standard was not fully inspected the staffing rota’s examined on the day confirmed that the home had a full staff compliment, with sickness and absence being appropriately covered. Residents spoken with reported that the staff were able to address their varying needs with care and kindness. The residents were complimentary regarding the skills and knowledge of the staff and stated that the staff were “very kind and caring”. A relative stated that they felt that the staff were “always too busy”. The staff personnel files examined did not contain information vital to ensure the safety of residents through the recruitment process. One file did not contain a POVA first/CRB check or two references, while one did not contain the two required references. Neither of the staff files contained a photograph of the member of staff. This issue was discussed on the day, and the manager was reminded that staff must not commence employment until the appropriate documentation was in place. The manager agreed that one new recruit due to
Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 19 start the following day would have their start date re-arranged to ensure the appropriate documentation was in place. Hatfield Haven did not have a staff training and development programme available for inspection. The proprietor stated that this was held at the head office. It was agreed that the programme must be held within the home to ensure that the manager/staff were able to identify and plan for their training needs. The staff spoken with on the day confirmed that they had been provided with induction and foundation training, but reported that refresher and ongoing training was “hit and miss” and was “not high on the agenda”. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 38. The newly appointed manager was not able to fully discharge their responsibilities. The induction process for the manager was not fully supported by the proprietor. This has resulted in the deterioration of some care practices and has increased the risk to the resident’s safety and welfare. The records in the home are not maintained to a level that ensures the ongoing health, safety and welfare of the residents. EVIDENCE: The newly appointed manager had been in post since mid January 2005. The manager had not received a completed and thorough induction and had not applied to the CSCI for registration. The manager has inherited a set of administrative systems that had been subject to requirements on previous inspections. The proprietor confirmed that he would be spending a substantial amount of time with the manager to improve the overall management of the home.
Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 21 While the residents made positive comments, the two relatives gave examples of poor staff practice, lack of confidence in the complaints process and overall a picture of poor communication. As previously stated the home record keeping was poor, records of water temperatures, fire alarm and emergency lighting checks were neither accurate nor up to date. The lack of a training programme and training records in the home was not satisfactory and the inspector was unable to fully confirm that appropriate staff training had been provided. The manager was not able to confirm her knowledge regarding legislation relating to the health, safety and welfare of both staff and service users. Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2
COMPLAINTS AND PROTECTION 3 x x x x x 3 x STAFFING Standard No Score 27 x 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 2 1 x x x x x 2 2 Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1)(c) Schedule 1 Requirement The registered person must ensure that the home has an accurate Statement of Purpose and Service User Guide. These documents when developed must be provided to all residents living in the home. The registered person must ensure that individual care plans contain all of the required information to enable the safe delivery of care. The care plans must record the issue the action and the outcomes of care. This is a repeat requirement from 21.10.04. The registered person must ensure that individual care plans contain an up to date risk assessment that identifies all elements of risk and action to address these needs. This is a repeat requirement from 21.10.04. The regsitered person must ensure that individual care plans contain evidence that residents and relatives are involved in the care planning process. The care plans must be reviewed on a monthly basis. Timescale for action 31.05.05 2. OP7 15 (1) (2) (c) (d) Immediate 3. OP7 12 (1) (a) Immediate 4. OP7 15 (1) 31.05.05 Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 24 5. OP8 12`(1) 6. OP15 16 (2) (i) 7. OP16 22 (1) (7) 8. OP29 7, 9, 19, (1) Schedule 2 9. OP30 18 (1) (c) (i) (ii), 12 (1) 9 (1) (2) 12 (1) 10. 11. OP31 OP38 This is a repeat requirement from 21.10.04. The registered person must ensure that individual care plans contained detailed information relating to the residents health care issues. The information must be updated to reflect when a change in need has occured. The registered person must ensure that a choice of meal is avaiable to residents, and that the menu is displayed to promote choice. The registered person must ensure that information relating to the specific dietary needs of residents is made available to kitchen staff. The registered person must ensure that an accurate and up to date Complaint procedure is available to residents and visitors. This procedure must be displayed and explained to residents. The registered person must ensure that the home has a robust recruitment process. The registered person must ensure that all appropriate checks are undertaken prior to appointment to ensure the safety of the residents. The regsitered person must ensure that the home has a staff training and development programme and must maintain training records for inspection. The registered person must ensure that the manager applies for registration with the CSCI. The regsitered person must ensure that the documentation and records in the home with regard to the health and safety of residents and staff are well maintained and accurate. 31.05.05 Immediate 31.05.05 Immediate Immediate 31.05.05 31.05.05 Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Hatfield Haven I56-I05 s17843 Hatfield Haven v221514 130405 stage 4.doc Version 1.20 Page 26 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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