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Inspection on 08/03/06 for Millerbank

Also see our care home review for Millerbank for more information

This inspection was carried out on 8th March 2006.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Ian Smith and Kelly Isherwood (the management team), made sure that Millerbank was the right place for service users to live, by meeting them before they came to live there and finding out about their needs. Service users spent time in the home before going to live there. This made sure that the staff working in the home knew what they needed to do to support people. The written information about service users` needs was detailed and useful. There was good and useful written information about how the service users should be supported and what they had agreed to do each day in order to improve and develop their lives. Service users were encouraged and supported by staff to do as many things for themselves as possible and to choose what they wanted to do each day. Service users stated that they appreciated the support and help given to them by the staff. One resident stated that he had had "a lot of support from staff" and that they had really helped to motivate him and improve his independence. Millerbank has consistently offered the service users very good opportunities to improve and develop themselves, such as educational and leisure activities. The routines of the home were also beneficial to the service users. One service user explained that they didn`t always feel like doing things, but staff encouraged them, as it is good for them. The meals and food served at Millerbank have been consistently praised for being healthy, appetising and enjoyable. One service user said that the food was "brilliant" The home and the service users benefited from strong and consistent management, and from a manager who is determined to improve the standards in the home. A service user said Millerbank was "the best home she had lived in". Millerbank provided the service users with a safe, pleasant and homely environment.

What has improved since the last inspection?

The service user guide had been rewritten. Service users had been involved in this process and it was a more attractive document and easier to understand. There was greater emphasis on encouraging residents` independence, for example service users were managing their own money and learning to manage their own medication. The information written down about the service users` needs, and what was required to improve their lives and independence had improved. There was clear evidence that service users were involved in the preparation of the care plans.

What the care home could do better:

Information regarding the risks associated with some activities and the way the risks are reduced and managed, for example going on holiday alone, must be written down and show clear management and support of these activities. Some medication procedures must be improved and made safer, for example the procedures followed when the medical practitioner changes doses of medication over the telephone.

CARE HOME ADULTS 18-65 Millerbank 27 Carlton Road Burnley Lancashire BB11 4JE Lead Inspector Mrs Pat White Unannounced Inspection 8th March 2006 10:00 Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Millerbank Address 27 Carlton Road Burnley Lancashire BB11 4JE 01282 423686 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) Tranway Associates Limited Miss Kelly Anne Isherwood Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must at all times, employ a suitable qualified and experienced manager who is registered with the Commission. 27th October 2005 Date of last inspection Brief Description of the Service: Millerbank is a care home registered to provide accommodation for six younger people, aged 18 to 65, with mental health problems. Tranway Associates Ltd own the home, and the Responsible Individual is Mr Ian Smith. Ms Kelly Isherwood is the registered manager. The home is an older type property close to Burnley town centre and service users therefore have easy access to the town’s facilities. There are 2 single bedrooms and 2 shared bedrooms. None have an ensuite. The home aims to provide a structured environment and routines, which endeavour to meet the needs of individuals, and encourage self – development and independence. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection, the purpose of which was to assess important areas of life in the home that should be inspected over a 12 month period, that were not inspected at the last inspection in October 2005, and to check any other matters which came to the inspector’s notice. There were no legal requirements or good practice recommendations made at the previous inspection. The inspection took 6 hours 30 minutes, and comprised of talking to service users, looking round the home, looking at service user’s care records and other documents, and discussion with the registered manager. A member of staff was spoken with. There were 5 service users living in the home at the time of the inspection but only 3 were available to talk to the inspector. Two service users spent some time in conversation; one refused. Some of their comments are included in the report. Comment cards were left for service users and relatives to complete and return to the CSCI. None were returned at the time this report was written. What the service does well: Ian Smith and Kelly Isherwood (the management team), made sure that Millerbank was the right place for service users to live, by meeting them before they came to live there and finding out about their needs. Service users spent time in the home before going to live there. This made sure that the staff working in the home knew what they needed to do to support people. The written information about service users’ needs was detailed and useful. There was good and useful written information about how the service users should be supported and what they had agreed to do each day in order to improve and develop their lives. Service users were encouraged and supported by staff to do as many things for themselves as possible and to choose what they wanted to do each day. Service users stated that they appreciated the support and help given to them by the staff. One resident stated that he had had “a lot of support from staff” and that they had really helped to motivate him and improve his independence. Millerbank has consistently offered the service users very good opportunities to improve and develop themselves, such as educational and leisure activities. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 6 The routines of the home were also beneficial to the service users. One service user explained that they didn’t always feel like doing things, but staff encouraged them, as it is good for them. The meals and food served at Millerbank have been consistently praised for being healthy, appetising and enjoyable. One service user said that the food was “brilliant” The home and the service users benefited from strong and consistent management, and from a manager who is determined to improve the standards in the home. A service user said Millerbank was “the best home she had lived in”. Millerbank provided the service users with a safe, pleasant and homely environment. What has improved since the last inspection? What they could do better: Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 7 Information regarding the risks associated with some activities and the way the risks are reduced and managed, for example going on holiday alone, must be written down and show clear management and support of these activities. Some medication procedures must be improved and made safer, for example the procedures followed when the medical practitioner changes doses of medication over the telephone. 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. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3 The admission procedures helped to assist prospective service users to make a decision about whether or not they would want to live at Millerbank, and whether or not their needs and aspirations could be met. EVIDENCE: The Service User Guide had been updated and improved, and residents had contributed to this process. Some terms and conditions of residence had been further clarified. The admission procedures, including the procedures for assessing prospective service users’ needs, and prior visits to the home, helped to determine whether or not a placement at Millerbank would be appropriate. Millerbank did not continue to provide a home for residents whose needs could no longer be met. One service user was in the process of moving to another placement. The other service users’ emotional, psychological and physical needs were being met. The registered manager ensured that these needs were met according to relevant clinical guidance, and that staff had the necessary knowledge and skills. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 10 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 The care plans were detailed and comprehensive, and assisted staff to understand service users’ needs. Service users were assisted in making choices and taking risks, to promote independence, however all of these activities must be supported by risk assessments. EVIDENCE: All the service users had detailed and comprehensive in house care plans that provided useful information for the staff. These had been further improved since the previous inspection and were goal orientated. They described detailed individualised procedures for service users and described any restrictions on choice and freedom that were agreed through the multi disciplinary team, for example alcohol consumption, home leave and going out alone. This was based on risk assessments (see below). There were also “Care Programme Approach” assessments and care plans from the multi disciplinary team. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 11 There was evidence that the service users were involved in the development and regular reviews of their care plans. Service users confirmed that they made their own choices in certain aspects of their life, such as going to college, what activities and hobbies to pursue. They confirmed that staff encouraged and supported them. One service user was benefiting from pursuing his interest in music and playing the guitar. Service users were learning how to manage their finances. The service users were being encouraged and supported by staff to become more independent and this involved taking responsible risks, such as going out alone, restricted consumption of alcohol of alcohol (see above). There were risk assessments to support some of these activities. However for one service user who had travelled alone abroad there was no written risk assessment, or details of the multi disciplinary team decision agreeing that he should go. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 12 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): 11, 12, 13, 15 & 17 Service users benefited from a wide range of opportunities for personal development, including educational and leisure activities and personal relationships. Service users appreciated and benefited from meals that were healthy and enjoyable. EVIDENCE: Service users were encouraged and supported in their personal selfdevelopment through educational, community and leisure activities. Some service users aimed to become independent enough to leave Millerbank to live in supported accommodation. Several service users had recently achieved this. All were encouraged to learn domestic and living skills, such as shopping and cooking their own meals. Two service users attended college courses. Some service users were encouraged to pay regular visits to the gym. One service user had joined a local band playing the guitar. Service users’ links with the community included visits to pubs, the cinema and restaurants and going shopping. A one weeks holiday was included in the contract price, and last year service users went to Minehead. Those spoken with said they were looking forward to going to Spain this year. Two service users spoke in positive terms about the routines and activities at Millerbank Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 13 and felt that they “were good for them”. One service user stated that they gave him a “structure and purpose to the day” and he appreciated the encouragement and support given by staff. Service users were supported to develop and maintain positive personal relationships. Appropriate links with relatives were encouraged, and several service users visited their families, and relatives visited the home. Service users were given advice and support in intimate personal relationships. Service users had some choice regarding activities and routines, for example one service user was concentrating on music rather than taking part in all the physical activities. Service users accepted that doing some household tasks, such as cleaning and food preparation, are part of normal everyday life and are useful routines to maintain for future independent living. Service users benefited from a healthy eating programme, which they helped to plan and prepare. Service users stated that they enjoyed the food served and one service user confirmed that she was responsible for her own food with staff help and support. One service user enjoyed cooking and praised the home for meals and food served. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 14 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): 19 & 20 Service users physical and psychological health needs were being met, but medication practices must be improved to further enhance service users’ health. EVIDENCE: Discussion with the manager and service users, and looking at records, showed that the service users’ physical and psychological health was monitored and matters addressed. All service users were part of the Care Programme Approach (CPA) and had regular contact with members of the community mental health team. Health screening was made available to those who agreed to it. Staff offered emotional support when needed, and this was confirmed in discussion with the service users who said that staff were supportive and available. The “assertive outreach team” was used at times for additional support. A registered mental health nurse was employed part time for therapeutic interventions. There were some good practices relating to medication management and administration. The home had policies and procedures that complied with the Royal Pharmaceutical Society guidelines and there was a 12 - week programme leading to service users administering their own medication. The Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 15 home checked the prescriptions prior to dispensing and verified the service users’ medication on admission. However one residents’ medication dose had been recently changed several times but there was no supporting written evidence of any instructions from a medical practitioner and no new prescription. The manager stated that the GP had refused to issue another prescription. Existing tablets had been halved to adjust the doses; one half placed in a labelled bottle and the other half placed in the bubble pack, which had been opened. The pharmacy inspector gave advice on this procedure and a number of requirements have been made. A label with new instructions had been stuck over the original instructions on the MAR sheet so there was no audit trail. Another dose change had been hand written on the MAR sheet but had not been signed by two people. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None Neither standard in this section were assessed EVIDENCE: Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 17 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 & 26 The home provided the service users with a clean, comfortable and homely environment in keeping with their age group and tastes. EVIDENCE: The home’s premises were suitable for their purpose. The property is a large, older, end of row terrace, close to the town centre. The home was well maintained and tastefully decorated and furnished. The bedrooms suited individuals’ needs and lifestyles and residents were encouraged to keep them clean and furnish them according to their personal tastes. One shared bedroom had been decorated and refurbished since the previous inspection. This had increased the privacy arrangements for the two occupants. As a home in existence before the National Minimum Standards were implemented in April 2002, Millerbank is exempt from meeting the standards on communal living and private space. The communal and private living space was the same as prior to April 2002. An extension was planned for office/ staff accommodation and a WC with disabled access. The registered person must submit the architect’s plans to the CSCI and consult with the fire service and building control. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 18 Though standard 30 was not assessed the home was clean and fresh at the time of the inspection. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 & 34 The service users benefited from the support of competent and qualified staff, and an effective staff team. The home’s recruitment procedures helped to protect service users from the employment of unsuitable staff but could be further improved. EVIDENCE: The staff training programme was constantly under review and development, to ensure that support workers have the skills and competencies to meet the service users’ needs. The target of 50 of staff being qualified to at least NVQ level 2 by the end of 2005 had been exceeded. All staff apart from the most recently appointed support worker had completed at least NVQ level 2. There was evidence that there was an effective staff team with a relatively low turnover of staff. The staffing levels were sufficient to meet the needs of the service users, and the service users spoken with confirmed that support workers were supportive and competent. Support workers were rostered according to the needs and activities of the service users. Regular staff meetings were held. Staff recruitment procedures were thorough, and helped to protect service users from unsuitable staff. However from the records viewed there was no evidence that the gaps in the employment record of one recently appointed support worker had been properly explored and documented. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 20 Although the standard on staff supervision was not assessed, the member of staff spoken with stated that he was well supported by the registered manager and the registered provider. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 The service users benefited from strong leadership and a well run home. The manager was well qualified and competent. EVIDENCE: Since her appointment about 4 years ago, the registered manager has consistently demonstrated strong leadership and commitment to raising standards, and meeting the Care Homes Regulations and the National Minimum Standards for Younger Adults. She has the relevant qualifications required for the registered manager and has demonstrated commitment to ongoing learning. Mr Ian Smith, the owner and responsible individual, supports the manager. Staff and service users view both the registered manager and the owner as being supportive and approachable. Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 x ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 x LIFESTYLES Standard No Score 11 3 12 4 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 x 3 X X X X X x Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No requirements made at 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 YA9 Regulation 13 (4)(b)(c) Requirement The registered person must ensure there are written risk assessments and management strategies to support service users’ independent activities including travelling alone. Original instructions on the MAR sheet must not be covered by later instructions. New instructions must be hand written. All hand written alterations and additions to the MAR sheets must be double signed (witnessed) and dated. There must be written supporting evidence, for example records of telephone conversations, for verbal/telephone changes in medication and the refusal of GPs to issue a new prescription Procedures must be developed to cover verbal/telephone medication dose changes and how to ensure the correct prescription and doses are obtained. Medication must be administered from the original container, and DS0000009507.V281792.R01.S.doc Timescale for action 08/03/06 2 YA20 13 (2) 08/03/06 3 YA20 13 (2) 08/03/06 4 YA20 13 (2) 08/03/06 5 YA20 13 (2) 31/03/06 6 YA20 13 (2) 08/03/06 Millerbank Version 5.1 Page 24 7 YA34 19 (1), sch 2 doses adjusted, at the time administration and there must be no tampering with the bubble packs. Gaps in employment must be fully explored and explanations recorded. 08/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Millerbank DS0000009507.V281792.R01.S.doc Version 5.1 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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