Inspection on 03/10/07 for Highfield House

This inspection was carried out on 3rd October 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Highfield House 19/09/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highfield House 70 Manchester Road Heywood Lancs OL10 2AN Lead Inspector Steve Chick Unannounced Inspection 3rd October 2007 10:00 X10015.doc Version 1.40 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 Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Address 70 Manchester Road Heywood Lancs OL10 2AN 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) 01706 624120 F/P 01706 624120 None Eagle Care Homes Ltd ** Post Vacant *** Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 25 service users to include: up to 25 service users in the category of OP (Older People). The service should employ a suitably qualified and experienced manager who is registered with the CSCI. 19th September 2006 Date of last inspection Brief Description of the Service: Highfield House is registered to provide personal care and support for 25 people aged 65 years and over, nursing care is not provided. Eagle Care Homes Ltd became the registered owners of Highfield House in March 2006. Highfield House is situated close to the centre of Heywood and provides easy access to all local amenities. Transport between Heywood and Rochdale is also easily accessible. The home provides 2 lounges and 2 dining rooms. There are 23 single bedrooms and 1 double suite; all have the provision of a private toilet with the double suite having a full bathroom. The home is set in its own grounds and has ample parking space. Externally there is an enclosed patio area, with access for wheelchairs and a large rear garden. The home welcomes visitors and as such operates no formal visiting hours. At the time of this inspection weekly fees were from £333. 70p to £350 per week, approximately £1446 - £1566 per month. Additional charges were for hairdressing, chiropody, toiletries and newspapers. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection. This key inspection included a visit to the service. The manager of the home was not informed beforehand that we were coming to do an inspection – this is called an unannounced inspection. All key inspection standards were assessed at this visit and information taken from the various sources, which included observing care practice and talking with people who live at the home, talking to people who visit the home, and talking to staff who work at the home. We are also spent time looking around the home, looking at records and talking with the management of the home. Before the inspection we sent surveys out to people asking them for their opinion on the service provided. At the time of writing this report we have not received any back. We also sent the manager a form called an Annual Quality Assurance Assessment (referred to as an AQAA). This form is for the owner and the manager to tell us what they feel they do well, what improvements they have made in the last 12 months, and what they feel they need to do better. We felt this form gave us some information about what the management of the home think, and we discussed this with them on the day. During our visit we spoke to 3 residents, 4 relatives and 2 members of staff. We also spent time with the owner of the home and the area manager for Eagle Care Ltd. What the service does well: Without exception the residents and visitors we spoke to said the staff were kind, caring and looked after them well. One relative said that they “feel to have peace of mind here”. Another relative we spoke to said that the “staff are very welcoming, and friendly”. The manager ensures that only people whose needs can be met are admitted to the home. Visitors are encouraged to visit their relative/friend whenever they wish. Care Plans were good and gave staff information on how to meet a resident’s needs. We saw evidence that residents medical and personal needs are attended to in a timely manner. Comments such as “ Wouldn’t be happier in any other home, I don’t worry about her here” were made to us. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 6 Staff spoken too felt confident they knew their job and received sufficient training to support them. Recruitment procedures showed that staff were only recruited after checks had been made on them such as references and police checks. This ensures only suitable staff are employed. Activities are available each afternoon and open to all to join in. We spoke to people who confirmed they could join in or not, as they wished. Food was said to be good with comments such as “dinners are quite nice, variety, and nicely cooked”. Food we saw supported this. Residents and relatives said they felt they could raise any complaint with the management. “If I am not happy , I would tell the staff and they would listen” is the type of comment made by several residents we spoke to. The environment is well maintained and residents encouraged to bring items of furniture and other possessions with them to make their room homely. We saw lots of examples of this. What has improved since the last inspection? What they could do better: The provider needs to consider more fully the information she puts into the AQAA. This information needs to be in depth and demonstrate all the improvements made and what the management feel they still need to do. The medication recording had a couple of minor errors. The manager needs to make sure that all staff account for medication given, or if not given they need to put the reason why not ie refused on the medication sheet. The provider should continue to undertake a quality assurance system within the home, to gather the views of the people using the service on a regular basis. This will provide the management team with up to date information on what residents feel works well and what could be improved upon. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment procedure in place supports that only people whose needs can be met are admitted to the home. EVIDENCE: Individual files are kept for people living at the home. A number were sampled and seen to contain assessments of their needs undertaken by social workers prior to admission. We also saw evidence that the manager visits people before they are admitted to undertake her own assessment so that she can be sure that the home is equipped to meet their needs. However if the manager is not able to do an assessment owing to the admission being an emergency she does reserve the right to ask people to make alternative arrangements if they cannot meet their needs. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 10 The statement of purpose and service user guide provides accurate and sufficient information for people to use in helping them make the decision as to whether they wish to live here. The information supplied to us by the provider prior to the inspection confirmed this as well. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and procedures in place ensure that residents health and personal care needs are met. EVIDENCE: Four care plans were looked at - this included looking at someone who had recently been admitted to the home and someone whose needs were complex. We found that the care plans were detailed in most respects and gave staff sufficient information on which to deliver a consistent level of care. Care plans contained nutritional information about what people liked to eat, and if there were concerns about weight loss we saw that the care plan addressed this. People are weighed regularly and this is documented on the care plans. In one instance the dietician had been contacted for a resident whose weight loss caused concern. This was documented although we could not see how this had Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 12 progressed as the record keeping had not been kept up. This was raised with the provider. Care plans were said to be shared with the resident and/or relative and whilst we did not see this consistently in the care plans we looked at, we did identify that it had been done for some people. A set of “sit on scales” is available in the home. People we spoke to who lived at the home said they felt their needs were attended to and that they received the right medical support when they needed it. We evidenced that doctors, dentists, chiropodists and district nurses all visited the home regularly and came when requested by the staff. We looked at the medication in the home and how it was stored, and administered. Senior staff are responsible for administering the medication and have received training. Overall, the medication system was safe, however we did notice that several entries on the medication record sheet had the code “0” against it to show that it had not been given, but no corresponding reason for why it had not been given was detailed. We also noted that for one person their eye drops had not been signed to show they have been administered during a period of 3 days – the reason entered for the omission was that the person was asleep, however there was no record that these had been administered when the person was awake. We were told by the senior that this was not the case, and they were sure they had been administered. A small number of other errors in medication recording were noted, and which were raised for the manager to address through the audit they undertake on the medication system. Relatives we spoke to said they were satisfied with the care, one relative said that they “feel to have peace of mind here”. Another relative we spoke to said that the “staff are very welcoming, and friendly”. They confirmed they could visit whenever they wanted, and said that “when running properly, it is great. Wouldn’t be happier in any other home, I don’t worry about her here”. A resident we spoke to said that “the girls check on me”. We also spoke to 2 staff, and asked them about how they provide care. They told us that they receive good communication about residents needs, and that they pass on information at handovers and write in the care plans any change of needs. They said they do not feel under pressure to make anyone do what they do not want to do, and residents are able to have their own routine of rising and retiring at the home, and having a lie in if they wish. One member of staff said that she likes the fact that “you have time to chat to the residents and the home is not too big.” Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 13 Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements in place at the home support residents to live a fulfilled life, alongside receiving varied food to their liking. EVIDENCE: A variety of activities are available for people to join in with as they wish. Most of the activities involved people coming into the home such as entertainers, or more recently a group of nursery children came to visit. Other activities such as clothes parties, and the Rochdale Library also come into to the home. Holy communion is available on Wednesdays. A notice board in the foyer details forthcoming events, and the provider does a regular newsletter informing everyone of what is coming up. We observed that preparations were underway on the day we were there for a Halloween party that night – supper of meat and potato pie and red cabbage was being prepared. All families and friends of the residents were invited. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 15 An activities organiser attends the home daily for the afternoon period. This was confirmed in discussions with staff and with people living at the home. One resident said that the best thing about living here is that “they leave you alone, and let you join in if you want”. Open visiting at the home was confirmed in the information provided by the provider, and through our observations whilst we were there. Several relatives we spoke to said they come visit whenever they wanted. One relative brings his dog in which is appreciated by the resident. Food was said to be good, the menu we saw showed plenty of variety and choice. One resident said “some have a cooked breakfast, but I just have cereals out of choice” and “dinners are quite nice, variety and nicely cooked”. Another resident told us that “they make cakes for birthdays, very good at doing things like that” and “very good food, and everything”. We spoke to the cook who told us that they have no difficulty ordering what they need and making the meals they like to make. She said that if someone does not like what is on the menu they will make something else for them that they do like. The cook holds her food hygiene certificate. We spoke with a member of staff, who confirmed that a choice of food is available, and that lots of activities do take place such as dough making, bingo, and at the moment Xmas cards. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives were confident that any concerns or complaints would be listened to and taken seriously. EVIDENCE: A complaints procedure is in place and included in the service user guide. Residents and relatives we spoke to said they knew who to speak to and were confident that should they raise any issues they would be addressed. One resident told us that she feels safe and that “staff treat you well, not like staff, more like friends”. She felt that they would listen to complaints and said she had not seen “anyone bullied”. Another resident told us that “everything is great, couldn’t have a better place” and “if I am not happy I would tell staff and they would listen”. Such comments were made by several residents. Some staff have received training in the protection of vulnerable adults, although not all. A number of staff also hold their NVQ2 and will have covered abuse in their training. However, of staff we spoke to all were conversant with what they would do if they suspected anyone was being abused, and one staff member said she “would pursue it” if necessary. Staff said they are encouraged by management to speak up about anything that concerns them. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 17 A complaints book is located in the entrance foyer, we noted that 7 recent entries had been made and all were positive about the care provided. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. A safe, and well maintained environment is provided for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We had a look round the home – not all bedrooms were entered, we sampled 3. Of those we went into all were nicely decorated, well furnished and had been personalised by the occupant. The manager told us that people are encouraged to bring furniture and possessions with them and room permitting they will accommodate them. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 19 One resident told us they felt their room was big enough, and that you can put anything you want up, they have their own TV and radio. They said that someone comes in daily to tidy and clean their room, and “they will make your bed if you leave it”. Another resident told us they “liked their room”. 2 relatives we spoke said confirmed they felt the home to be kept clean and tidy and “not smell”. An internal patio is available which offers resident the opportunity to have some fresh air in a safe environment. Appropriate sitting out furniture is provided to this area to accommodate this. Two lounge areas and two dining areas are provided. These areas were seen to be well maintained. The provider told us that all the rooms are en-suite and all taps have been fitted with thermostatic controls to ensure that hot water is delivered at a safe temperature. We observed the home to be clean and tidy, and odour free on our visit. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 20 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. Sufficient staff are employed to meet resident needs, with training provided to support their ability to deliver consistent care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota we looked at showed sufficient staff were employed for the dependency levels of the residents. Staff we spoke to said they felt that sufficient staff were on duty and one replied “yes, we do not struggle”. Another member of staff said they felt to work with “a nice bunch of girls”. Staff spoken to said they received induction which they considered to be appropriate to their needs. This was confirmed in the records we looked at. Staff have received training particularly in moving and handling (with more dates arranged for staff), 1st aid and dementia training. Of a staff group of 14,, a number of staff hold their food hygiene and 7 have completed NVQ2 Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 21 with 3 currently doing NVQ3 and 4 planning to do so. Both cooks hold their food hygiene certificates. Residents we spoke to were complimentary about the staff and said “staff who we know are pleasant, not aware of any unpleasantness from staff”. Relatives did say that they were aware that at time the home was short-staffed but said they were aware that this was due to sickness at the last minute not because the home does not have sufficient staff. This was said to have been brought up at residents meetings with the management. 2 staff files were looked at and contained all the necessary information including evidence that the staff are appropriately checked out before they commence work at the home. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 22 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. Management responsibilities are fulfilled, and residents interests promoted so that residents live in a home suitable for their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has been without a registered manager for some time, and whilst a manager had been recruited to this position she left the employ of the company suddenly without having commenced the registration process with the Commission For Social Care Inspection. Eagle Care Homes Ltd who own Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 23 the home have put management arrangements in place with the internal appointment of a member of staff. This person has commenced the process of registration. We left some surveys with the provider to distribute to relatives or to leave in the foyer for relatives to help themselves. At the time of writing this report we have not received any surveys back from relatives giving us their views of the service. A quality assurance system is in place at the home, although the information we were shown was some 10 months old. The provider said that regular audits are undertaken at the home and they do seek to gather the opinions of the people living at the home, working at the home and visiting the home. We saw minutes of the last relative/resident meeting on 8/10/07 which supports the provider in seeking views of the service provided. We looked at the personal allowances for 3 people and all looked to be in order. Safety records were looked at and these showed that the equipment and fixtures in place receive regular maintenance at appropriate intervals. The fire officer from the local station has been in recently to provide a fire lecture and staff are just waiting for the certificates to arrive. The provider undertakes regular visits to the home and completed a visit form evidencing what she has looked at and who she has spoken to. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP33 Good Practice Recommendations Staff should be more vigilant in recording on the medication sheets. Where they have not administered medication they should indicate the reason ie refused. The quality assurance system in place should be undertaken again to provide more up to date information on the views of the people using the service, so that the provider and manager can consider what works well for residents, and what needs to be changed. Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 26 Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highfield House DS0000066357.V355888.R01.S.doc Version 5.2 Page 28 - 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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