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Inspection on 14/07/05 for Hedgerows Nursing Home

Also see our care home review for Hedgerows Nursing Home for more information

This inspection was carried out on 14th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The Hedgerows was clean and free of offensive odours. Staff were described by one service user as kind and caring. They also spoke of how reassured they were to be in this particular home where they considered the care to be very good. The home has a stable staff team and appropriate training is being addressed and undertaken. It was noted that service users seen looked clean and tidy and their comments about the service they received were very positive. The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home

What has improved since the last inspection?

"Person Centred Planning" will be introduced to ensure service users plans are more involving and they can take ownership and responsibility for their own self. The home now has a registered manager. The home operates a work based induction programme which is competency based and has currently been reviewed. The Manager is ensuring the home`s induction programme is to TOPSS standards.

What the care home could do better:

The admission procedure did not always include an adequate assessment which ensures that service users needs can be met. While improvement has been made to the care planning process some further progress is required to ensure that service users needs are met and that risk assessments are maintained.Some aspects of medication administration and recording was not being addressed appropriately. Restraint training must be addressed as service users were being restrained with lap belts in chairs with no documentation in their plans of care or risk assessments. The screening of double rooms should be reviewed to ensure privacy and dignity to all service users.

CARE HOMES FOR OLDER PEOPLE Hedgerows Nursing Home 256a Ongar Road Brentwood Essex CM15 9DX Lead Inspector Helen Laker Un-announced 14th July 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. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hedgerows Nursing Home Address 256a Ongar Road, Brentwood Essex CM15 9DX 01277 202270 01277 215520 hedgerows@outlookcare.org.uk Outlook Care Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Simon Chua Kim Chuan CRH 40 Category(ies) of Dementia over 65 DE (E) 6, registration, with number Learning Disability LD 6, of places Old Age OP 34 Physical Disability PD 34 Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th and 10th December 2004 Brief Description of the Service: The Hedgerows is a purpose built bungalow complex sited around a courtyard. Two of the bungalows provide for fourteen service users one provides for twelve service users. Each one has its own attached small well-maintained garden.The bungalows are situated within the grounds of Highwood Hospital, close to the centre of Brentwood. The location is convenient to a local bus service and benefits from having a small parade of shops close by.At present the home provides for six learning disability clients, six service users with dementia, and thirty four physically disabled older people with nursing needs. The home has currently reduced it’s occupancy to a total of forty service users. At the time of this report, four beds were contracted by the Primary Care Team for transitional service users prior to permanent placement in residential or nursing care homes or community based home care. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection which took place over six hours with one inspector in the home. There was a tour of the premises and grounds and an inspection of records and documentation. Time was spent discussing the care of the service users. The manager in charge of the day to day management of the home, staff and service users were spoken with. Twenty seven National Minimum Standards were inspected on this occasion, twenty seven overall outcomes were met and there were five requirements and two recommendations detailed in the full report. Discussion of the inspection findings took place with the manager in charge of the day to day management of the home at the end and throughout the inspection, guidance was given. What the service does well: What has improved since the last inspection? What they could do better: The admission procedure did not always include an adequate assessment which ensures that service users needs can be met. While improvement has been made to the care planning process some further progress is required to ensure that service users needs are met and that risk assessments are maintained. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 6 Some aspects of medication administration and recording was not being addressed appropriately. Restraint training must be addressed as service users were being restrained with lap belts in chairs with no documentation in their plans of care or risk assessments. The screening of double rooms should be reviewed to ensure privacy and dignity to all service users. 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. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 7 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 Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 8 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 has a comprehensive Statement of Purpose and Service User’s Guide. Present and prospective service users and their supporters are given adequate information about the home so that they can make informed choices. The admission procedure did not always include an adequate assessment which ensures that service users needs can be met. The home provides a caring environment where visitors are made welcome. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User’s Guide. The statement of purpose incorporates all recommended criteria. The service user guide is user friendly, in a relevant format and provides an overview of the home and services available. Both documents have been reviewed to clarify the home categories and provision of service to transitional residents. The home acknowledges that it does not take service users with the dementia category. A sample of care plans seen demonstrated that a full assessment has generally been undertaken prior to admission. Those service users admitted through care management arrangements included assessments from the relevant authorities. This had not happened for one service user whose assessment was incomplete and no care plan had been formulated. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 9 Four transitional service users are based in one bungalow to provide dedicated space. Service provision and evaluation of staff competence regarding short stay care has been developed. Specific procedures and policies promoting independence and mobility were discussed on the day of inspection. Service user feedback and consultation with the placement officers and discharge coordinator are in place to support development of the service. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Each service user has an individual plan and service users are supported to take risks as part of an independent lifestyle via a process of assessment. While improvement has been made to the care planning process some further progress is required to ensure that service users needs are met. The health needs of service users are well met although better documentation would ensure clarity of needs. Some aspects of medication administration and recording was not being addressed appropriately. Personal support is provided in a way that promotes dignity. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 11 EVIDENCE: It is noted that comprehensive person centred plans currently in draft form are to be finalised and implemented. Evidence of three service user care plans indicated that their basic health, personal and social care needs are recorded within an individual plan of care. Instructions for staff to meet service users’ care needs were clear and comprehensive. Care plans did not always evidence service users’ or relatives’ involvement. Care plans seen were reviewed on a monthly basis. Daily recording requires improvement to ensure they detail the welfare of the service user, how they spend their day and the progress of the care plan. One new service user had no care plan at all. Risk assessments were available for some service users but were also noted to require more detail and include potential complications of the risk. Transitional care plans did not always include photos, missing person profiles, assessment tools likes and dislikes, evaluation of care needs thorough monthly review and a more standard approach. The manager was advised of these issues during the inspection. Care plans evidence that service users are enabled to access all community health services On inspection of the homes medication administration records it was noted that on several occasions recording omissions had occurred and signatures had not been obtained. This was discussed at the time of inspection. The inspector was informed that only trained staff administer medication. Completed drug histories should refer to dose changes on the form. All individual entries on the drug sheets should be signed by the transcriber and checked for accuracy. The dose form and strength of medication should be clearly recorded on treatment charts. Covert medication procedures should be clearly documented in care plans where applicable. Standards of privacy are available and respect for service users is covered in the staff induction programme. The majority of bedrooms are double rooms. There is screening available, although this does not always provide sufficient privacy. The Manager is aware and is reviewing the situation. A visitor’s room is available in one of the cottages. In addition, private space in the office accommodation can be made available. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 12 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) 12,13,14,15 Social activities take place and service users are generally happy with the choices in routine available to them Visitors are made welcome and overall the service users rights and responsibilities are recognised in their daily lives. EVIDENCE: The home has one full-time activities organiser. Additional activities are organised by staff up to a maximum of hours which equates to 2.2 full-time staff. A wide range of activities are available inside the home and in the local community. The home has access to a minibus and disabled taxi service. A light and sensory room is available. Activities of daily living are documented in the care plans. The Manager stated that the home operates an open visitor’s policy and encourages relatives to be involved in the home. There is a relatives’ group which meets regularly. The home promotes the use of an advocacy service for its service users. An advocate chairs the service users’ meeting and is involved in service users’ care reviews where no relatives are available. There was evidence of service users personalising their rooms to their individual tastes. Each bungalow has its own kitchen facilities and a cook. Service users’ likes and dislikes are recorded in their care plans. Individual nutrition assessments are undertaken on admission. Nutrition records are maintained and regular checks on the refrigerator and freezer temperatures are maintained. All food Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 13 is temperature checked before serving. All three kitchens have been refurbished since the last inspection. Service users spoken with all said the food supplied was to a good standard and choices were always available. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 14 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 has effective procedures in place to ensure that service users are protected from abuse, neglect and self harm. EVIDENCE: The home has an appropriate complaints procedure which is displayed in each bungalow. Records are kept in each bungalow and a master complaints log is maintained at the Proprietor’s head office to monitor trends and incidences throughout all the group’s homes. This had not been kept up to date. Up-to-date protection and whistle blowing policies are available in each bungalow. Positive response workshops are available for staff. There are procedures in place for dealing with aggression and challenging behaviour. Staff have received training on abuse on induction and protection of vulnerable adults training for staff is planned. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20.21,22,23,24,25,26 The Hedgerows was clean, bright and well maintained and provided the service users with safe, homely and comfortable surroundings. Improvements have been made to the décor of the home. Not all staff are aware of the fundamental concepts of restraint. EVIDENCE: The home’s accommodation is provided in three self-contained bungalows – “Hawthorn, Bluebell and Foxglove”. Each provides a homely environment for the service users. The surrounding grounds are well maintained with seating provided. The Manager has monthly meetings with the Estates Manager regarding all maintenance of all the bungalows. Records of maintenance are maintained. Each bungalow has a dedicated lounge and dining areas and carpet has been replaced in these areas in Foxglove and Bluebell bungalows. Transitional service users have their own dedicated accommodation with their own communal areas Each bungalow has two bathrooms and a shower room and six toilets. None of the bedrooms have ensuite facilities Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 16 The bungalows are purpose-built. They all have a service user call system, hoists and lifting and handling equipment. Hawthorne bungalow has a sensory garden. The accommodation in terms of bedroom space meets the standards for homes registered before August 2002 All bungalows were decorated to a good standard. All service users’ bedrooms were seen to be personalised to individual tastes and have doors with locks and some were equipped with lockable facilities. The home provides adjustable beds, allocated by service user’s needs. The screening in double rooms did not ensure the dignity and privacy of service users. The manager is currently investigating this. Service users were being restrained with lap belts in chairs with no documentation in their plans of care or risk assessments. All bungalows were seen to be bright and airy. All rooms were naturally ventilated and centrally heated and had adequate lighting. Health and safety inspections are carried out by the NHS Estates Department. Hot water monitoring is carried out on a regular basis. All bungalows were seen to be clean and tidy and odour free. Adequate laundry and sluice facilities are provided. Infection control procedures are in place and regularly reviewed. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The procedures for the recruitment and training of staff have safeguards in place to offer protection to people living in the home. The home has an effective and competent staff team. EVIDENCE: Hedgerows are complying with the staffing notice agreed in March 2002 by South Essex Health Authority, the previous regulatory authority. The Manager reviews skill mix and dependency levels as an ongoing process. Agency and bank staff are currently being used to cover vacancies, holidays and sickness. Staff files examined contained all the information required to meet this standard. Evidence of national insurance numbers was discussed. Job descriptions for all grades of staff were seen to be appropriate. The home operates a work based induction programme which is competency based and has currently been reviewed. Appraisals are used to assess individual training needs. The home’s pre-inspection questionnaire evidenced that staff receive foundation training. The Manager is ensuring the home’s induction programme is to TOPSS standards. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 18 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) 31,33,35,38 There is guidance and direction to staff and the home has in place practices that will promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The new Manager took up his post on 1st November 2004. He is a qualified RNMH and holds the Diploma in Management Studies. He has twenty-four years nursing experience of which fourteen years have been at management level. His application for registration has now been processed and approved. Outlook Care has achieved ISO9002 accreditation and Investors in People. The Proprietors have formed a steering group for quality assurance monitoring. The home holds audits every six months on local standards and an advocacy forum is held on a monthly basis. The home has a development plan and there are plans to introduce service users and stakeholders’ quality questionnaires. An appointee from the Proprietor’s Head Office is available for service users who cannot manage their finances. Generally, finances are managed by service Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 19 users’ families. Records and receipts are kept for all transactions for each service user. The Manager is fully aware of his responsibilities for health and safety and staff receive regular training on health and safety. Restraint training must be addressed as service users were being restrained with lap belts in chairs with no documentation in their plans of care or risk assessments. Health and safety checks are regularly carried out by NHS Estates Management Team. Safety certificates were available for gas, electric and fire, call systems, hoists and prevention equipment. Regular checks were seen for hot water and fire equipment. Regular fire drills were seen to be being carried out. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x x x 2 Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 21 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 3 Regulation 14 (1) & (2) Requirement New service users must be admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. A detailed service user plan of care must be drawn up including consultation with service user families and significant multidisciplinary personnel, to be reflected in the care plan and reviewed comprehensively monthly. Risk assessments must be carried out for the example: -use of bed rails and includes details of potential implications of their use for the service users within individualised plans of care. This with regard to all other risk assessments formulated especially those at risk of falls, pressure sores and those for COSHH and environmental health and safety issues. The registered person must ensure that there is a policy and staff adhere to the procedures Timescale for action 15th September 2005 2. 7 15 (1) & (2) 17(1) (a) & (b) 15th September 2005 3. 7 & 38 13 (4) & 13 (8) 15th September 2005 4. 9 13 (2) 17 (1) 12 (1) – 15th September 2005 Page 22 Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 (4) 13 (4) 14 (2) 5. 24 & 38 13 (7) & (8) for the receipt of recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. Service users must not be restricted with lapbelts permanently for any reason or be subject to any form of restraint. Consideration must be given to the issue of formulating individual plans within a riskmanaged strategy. 15th September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 16 24 Good Practice Recommendations It is recommended that the master complaints log is kept up to date to monitor trends and document accurate actions taken and complaint outcomes. The screening of double rooms should be reviewed to ensure privacy and dignity to all service users. Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on sea, Essex SS2 6BG National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Hedgerows Nursing Home I06-I56 S15538 The Hedgerows V232528 140705 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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