Inspection on 24/10/05 for Kenrick House

This inspection was carried out on 24th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kenrick House 22/11/07

Kenrick House 27/05/07

Kenrick House 04/07/06

Kenrick House 15/03/06

Kenrick House 23/03/05

Kenrick House 11/11/04

Kenrick House 25/02/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Kenrick House 1777 Pershore Road Cotteridge Birmingham West Midlands B30 3DP Lead Inspector Gerard Hammond Unannounced Inspection 24th October 2005 04:00 Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 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 Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kenrick House Address 1777 Pershore Road Cotteridge Birmingham West Midlands B30 3DP 0121 451 2511 0121 246 6833 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) Mrs Charmaine Doherty Ms Rosemarie Brown Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Residents must be aged under 65 years Three residents with a learning disability. The home can continue to accommodate one named service user over the age of 65 with a learning disability. That the home applies for a variation on behalf of future service users who are each the age of 65 years. The details regarding how the specific care and social needs of the named person must be included in the service users plan. That all care staff in the home must receive training in caring for older people by 1st October 2005 and a record of this training maintained. That the named service user over 65 years` care plan, is kept under review to ensure that their needs can still be met. 19 March 2005 Date of last inspection Brief Description of the Service: Kenrick House is registered to provide accommodation, care and support for up to three people with learning disabilities. The house is a domestic scale, twostorey terraced property situated on a main arterial route into Birmingham at Cotteridge. On the ground floor there is a lounge, separate dining room, kitchen, office / staff sleep-in room, and toilet. Upstairs are three single bedrooms, a bathroom with over bath shower facility and toilet, and a separate shower room used by staff. The front door gives access directly onto the pavement outside the house, and there is restricted parking on the road outside. There is additional parking in nearby side roads. To the rear of the property is a small, enclosed garden. There is a wide range of local amenities within walking distance of the house, at either Cotteridge or Stirchley, and the area is well served by public transport. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Direct observation and sampling of records (including personal files, previous inspection reports and safety records) were used for the purposes of compiling this report. The Registered Manager was formally interviewed, and the Inspector met with one of the residents. Unfortunately, the other resident was in hospital on the day of the inspection visit. A tour of the building was also completed. What the service does well: What has improved since the last inspection? It should be acknowledged that this has been a difficult time for both management and staff teams in the Home, while they are dealing with the serious illness of one of the residents. Attempts have been made to address some of the requirements made at the time of the last inspection. Contracts are now in place in residents’ personal files. Improvements have been made to the regular testing (and recording of tests) of the fire alarm system. A new shower with a pre-set temperature control has been installed in the bathroom. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 6 What they could do better: New contracts should be signed by all parties concerned. Care plans need to be developed: information about how support should be given lacks sufficient detail. This should be expanded so that it is quite clear exactly how much support people need, and that staff giving support are made aware of people’s preferences and know precisely what they should do. Plans should include people’s personal goals, and these should be written in such a way that it is possible to measure whether or not they have been achieved, when the plan is reviewed. Risk assessments also require further development, so that potential hazards are correctly identified, and that control measures are used to inform individual care plans appropriately. It is recommended that care plans and risk assessments be numbered and indexed. Risk assessments should be directly cross-referenced to the care plan(s) to which they relate, and vice versa. Recording of activities needs to improve, and activities should be directly linked to people’s care plans and goals. Medication Administration Records must medicines stored securely at all times. be completed accurately and A staff training and development plan is required, and the provision of opportunities for formal supervision of staff needs to improve. 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. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Residents’ needs have been assessed, but statements of need should be reviewed. Residents have individual contracts, but these should be signed by all parties concerned. EVIDENCE: There have been no admissions since the last inspection, and both the current residents have lived in the house for a number of years. Sample checking of one resident’s personal file found appropriate assessment information in place, but it is not clear how and when this has been reviewed. It is important that individual assessments are kept under review, so as to inform future care planning appropriately. A requirement was made at the last inspection that individuals’ contracts required development. A new contract is now in place, but these should be signed by residents and/or their representatives, as well as the Registered Manager. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Care plans need development so that they contain sufficient detail and also reflect residents’ individual goals. Residents do make decisions about their lives, but this needs to be reflected in their individual plans. Risk assessments are in need of development so that hazards are correctly identified, and appropriate measures put in place. EVIDENCE: Care plans are in need of significant development, so that it is clear to the reader exactly how support should be given. For example “needs support to dress” should indicate precisely what is required. Can this person choose their own clothes and are they aware of how to dress according to the weather? Are they able to put garments on, but need help to do up buttons or zips? It is important that the plan contains sufficient detail so that the person giving support knows exactly what they should be doing. Similarly, another entry says, “Needs to drink regularly” (because of a specific medical condition), but gave no indication of how much or how often, or of how this should be monitored. Consideration should be given to expanding all elements of current Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 10 care plans to ensure that sufficient information is in place to give appropriate guidance. It may well be that members of the current care team have this knowledge, but it is important that this is reflected in people’s care plans. Risk assessments are confused with care plans, and hazards are not correctly identified. One entry says, “no mobility problems identified”, but elsewhere in the file there is information that this resident can walk short distances and has occasional arthritis. There is no indication about whether or not she can manage steps outside of the home environment, or an escalator, or (for example) whether she is able to get on or off a bus unaided. Risk assessments should identify potential hazards, make a judgement about how likely it is that exposure to the identified hazard may occur, and suggest control measures to eradicate it or minimise the likelihood of occurrence. The control measures should then be used to inform that person’s care plan. Risk assessments and care plans should be directly cross-referenced. It is recommended that plans and risk assessments are numbered and indexed in order to make this task easier. A requirement was made at the time of the last inspection that care plans should also show how residents have been involved with decisions about their lives, and this remains outstanding. The previous inspection report found that daily records and residents themselves indicated that they were able to make choices about their lives. Care plans should include residents’ personal goals, and these should be recorded in such a way that it is possible to see whether or not these goals have been met, when the plan is reviewed as required. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Residents are able to take part in appropriate activities and to access the local community, but recording of this needs to improve. People living in the house are supported to keep in touch with their families and friends. EVIDENCE: At the time of this inspection, one of the residents, who has been seriously ill, was away receiving treatment at a local hospice. The other resident has a structured day programme at local centres, and has attended for many years. She also goes out to local shops and hairdressers. There is little information on file about the activities she enjoys or would like to pursue. Her day programme should be viewed as an integral part of her overall care package, and not something that “goes on over there”. While it has to be recognised that this person is a woman over the age of retirement, and that an excessively busy activity schedule might be inappropriate, her care plans and records should reflect the range of activities she currently pursues, and reviews should seek to address whether or not these still meet her requirements. It may well be that Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 12 these issues are being addressed, at least in part, but records do not currently reflect this. Residents are supported to keep in touch with their families. One resident makes weekend visits regularly, and stays over. During these visits she is able to go to her local church with family members. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Residents receive a good standard of basic personal care and healthcare needs are generally met, but care plans need to be expanded so that an accurate judgement can be made about whether or not support is given appropriately in accordance with assessed needs and preferences. Arrangements for storage, handling and administering medication need to improve. Issues relating to the serious illness of one resident have been dealt with respectfully and sensitively, in accordance with their wishes. EVIDENCE: As mentioned earlier in this report, care plans are in need of development so that they contain information in sufficient detail to guide members of the care team as to how support should be given, in accordance with their preferences and assessed needs. It is recommended that introducing person-centred approaches into the care planning process might help to improve this. A tool such as ELP (Essential Lifestyle Planning) might prove useful in this regard. The general appearance, grooming and attire of the resident at home during the inspection visit, provided evidence that she is in receipt of a good standard of basic personal care. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 14 The Medication Administration Record was examined and it was noted that there were gaps in recording. This has been a problem in the past, and steps must be taken to ensure that records accurately reflect medicines actually given in accordance with prescribing instructions, or provide appropriate information in relation to any discrepancies. It was also noted during the course of the inspection visit that the medicine cabinet had been left unlocked with the keys in the door. This has been a very difficult period of time for staff, trying to support one resident who is seriously ill, while ensuring that the needs of the other person living in the house continue to be met. There is evidence on people’s records that appropriate support and guidance from healthcare professionals has been sought as required. Conversations with the Manager show that the issue of one resident’s illness has been dealt with in a sensitive and respectful manner, recognising her needs and her right to confidentiality in particular. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 It is difficult to assess accurately whether or not residents feel that their views are listened to and acted upon. General practice provides residents with protection from abuse, neglect or selfharm. EVIDENCE: On the day of the inspection visit neither the complaints nor the adult protection policies and procedures were available for inspection in the Home, as required. Copies of these documents have since been made available to CSCI. It should be acknowledged that the communication needs of the resident seen during the course of the inspection mean that a formal complaints procedure is unlikely to have any relevance for her directly, and that she is dependent on the vigilance of staff and their knowledge and experience of her particular ways, to be aware if she is unhappy or distressed. It is recommended that the adult protection policy is cross-referenced with local multi-agency guidelines, and that these are filed with the policy as an appendix. The Manager has recently obtained information concerning an agency offering adult protection training, and is now pursuing this option to arrange for members of the staff team to enrol on a course. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Kenrick House provides residents with an environment that is safe, comfortable and homely. The home is kept clean and tidy, and staff maintain a good standard of hygiene. EVIDENCE: Staff do their best to ensure that the house provides residents with a warm and welcoming homely environment in which to live. The house in general is comfortable, and fixtures, fittings and furnishing are of an appropriate standard. People’s rooms are individual, with personal effects and possessions in evidence. At the time of the last inspection there was a problem with the upstairs bathing facilities. A new safety shower has now been installed, with a preset temperature control. The house is kept clean and tidy, and a good standard of hygiene maintained. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36 A training and development plan is required in order to assess whether or not the staff team is adequately trained. Arrangements for formal supervision of staff need to be improved. EVIDENCE: Staff files were not examined in detail on this occasion: these will be assessed more fully at the next inspection. A staff training and development plan is required. This should show (for each member of staff employed at the Home) details of all training completed and qualifications obtained to date. The plan should highlight any gaps, including “refreshers”, and indicate when outstanding training is scheduled, and who is to deliver it. There is an outstanding requirement that staff should receive training in First Aid, and also Food Hygiene. Records show that formal supervision is not up to the required standard, and this must be improved. Each member of staff should have a formal supervision meeting at least six times in any twelve-month period (pro rata for part time staff), with written records maintained. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 General practice promotes the health, safety and welfare of people living in the house. EVIDENCE: Safety records were sample checked. The fire alarm has been tested weekly, and a record kept, as required. Fire evacuation drills have been carried out as necessary: it should be noted that the record of such drills should include the names of all people taking part. A record has also been maintained of the temperature at all water outlets. The accident book was also examined. The format of the book in use complies with the requirements of current data protection legislation. However, the practice of retaining completed reports in the book does not. Reports should be filed on the personal records of the individual concerned. It is recommended that the counterfoil stub be marked with the date and the initials of the person concerned, to enable reports to be tracked if required. Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Kenrick House Score 2 3 1 3 Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000017063.V262321.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA5 Regulation 5(b-c) Requirement Timescale for action 31/12/05 31/12/05 3 4 Contracts should be signed by all parties concerned. YA6YA7YA18 15(12)12(3) Care plans should be 12(4a) developed as indicated in the main body of this report, to include sufficient detail so as to guide staff exactly in how support should be given. Plans should also reflect residents’ personal goals and preferences, and indicate how they have been involved in decision making. Outstanding since 19/03/05. YA9 13(4a-c) Risk assessments should be developed so that potential hazards are identified correctly; the level of risk identified clearly, the likelihood of occurrence and control measures included. Risk assessments must be reviewed regularly. Outstanding since 19/03/05 YA20 13(2) All medication administered must be signed for. The Medication Administration Record must be completed accurately at all times, and include an explanation if DS0000017063.V262321.R01.S.doc 31/12/05 25/10/05 Kenrick House Version 5.0 Page 21 5 YA35 18(1c) 6 YA36 18(2) 7 YA40 12(1) 22(2)(4-5) prescribed medication is not given. All medicines must be stored securely at all times. Immediate requirement. A staff training and development plan, as indicated in the main body of this report, should be forwarded to CSCI. Each member of staff must be formally supervised at least six times in any twelve-month period (pro-rata for part-time staff) and a written record of each meeting maintained. Written policies and procedures must comply with current legislation and recognised professional standards, and cover the topics set out in Appendix 2 of the National Minimum Standards (Younger Adults). Outstanding since 19/03/05 – not assessed at this inspection. 31/12/05 31/12/05 31/01/06 Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 22 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 3 Refer to Standard YA5 YA6YA9 YA12YA13 Good Practice Recommendations It is recommended that contracts provide the option of signature or witnessing by an independent person, where residents are unable to sign for themselves. Numbering and indexing care plans and risk assessments will make it easier to locate information and to crossreference. Personal records should include information about structured day programmes (e.g. day centre activities), and these should be linked directly to care plan goals. This will help planning to reflect a “whole life” approach. Consider how person-centred approaches can be introduced, in keeping with the aspirations of “Valuing People”. Essential Lifestyle Planning might prove a useful tool in developing support plans with residents. It is recommended that the adult protection policy is directly cross-referenced to local multi-agency guidelines, and that a copy of the guidelines is filed with the policy as an appendix. Mark the counterfoil stubs in the Accident Book with the date of the report, and the initials of the person concerned, to enable reports to be tracked if required. Put a prominent note on the Book to remind staff of the need to make reports to CSCI as required by Regulation 37 (Care Homes Regulations 2001). 4 YA18 5 YA23 6 YA42 Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Kenrick House DS0000017063.V262321.R01.S.doc Version 5.0 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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