CARE HOME ADULTS 18-65
Pierpoint House Nursing Home Pierpoint House Nursing Home 385 Clifton Drive North St Annes On Sea Lancashire FY8 2NW Lead Inspector
Mr Kevan Royston Unannounced Inspection 17th January 2007 09:00 Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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 Pierpoint House Nursing Home DS0000006070.V328590.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 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. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Pierpoint House Nursing Home Address Pierpoint House Nursing Home 385 Clifton Drive North St Annes On Sea Lancashire FY8 2NW 01253 723144 01253 720377 unitmanager@pierpoint.co.uk or admin@pierpoint.co.uk Mr John Noel Grady ACIB 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) Julie Elizabeth Townsley RMN, N.DipM. Care Home 29 Category(ies) of Past or present alcohol dependence (29), Past or registration, with number present drug dependence (29) of places Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may accommodate up to a maximum of 29 persons who are over the age of 18 years with either past or present alcohol or drug dependence, to include a maximum of 9 persons undergoing detoxification and 2 persons with bulimia/compulsive over eating disorders. A suitably qualified and experienced manager who is registered with the NCSC must be employed at all times. 12th October 2005 2. Date of last inspection Brief Description of the Service: Pierpoint House is a care home offering primary care to 29 adults of both sexes who suffer from substance abuse, dependency or addiction. Nine of the beds are specifically for detoxification treatment therefore nursing staff is employed. Most people receiving treatment are accommodated for approximately two to twelve weeks. The home is converted from a large Victorian property. The accommodation is on the ground, first and second floor. One room is en-suite and additional bathing and shower facilities are provided. There are two lounge areas, one activity room plus individual therapy rooms. The bedrooms consist of six double bed rooms, six single rooms, two three bedded rooms and one four bedded. There are garden areas to the front and rear of the property. The home is situated near the busy shopping area of St Annes close to public transport bus and tram routes. There is a statement of Purpose/Service user Guide, which is given to all prospective residents. This written information explains the care service treatment programme that is offered, who the owners and staff are and what the resident can expect if he or she decides to go on the rehabilitation treatment programme. The fees at the home range from £571.00 to £1785.00 per week. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 17th of January 2007 over a period of approximately six hours. The Inspector spoke to the manager; four staff, two of which are employed as support workers, and three residents. Comments were positive about the standard of care provided, how the rehabilitation programme was delivered and support from staff and the management team. As part of the inspection process the inspector used case tracking as a means of assessing some of the National Minimum Standards. The process allows the inspector to focus on a small number of people living at the home. All records relating to these persons are examined and the rooms they occupy are looked at. Other residents are invited to pass their opinions to the inspector if they wish. Surveys were sent for the residents to comment on the care and general running of the home but none were returned. Records of three members of staff were also examined. A tour of the premises was undertaken. Examination of the homes documentation, policies and procedures formed the basis of the inspection process. What the service does well:
The staff team consists of health and social care support professionals available at the home daily and supporting each resident on their individual programme ensuring they get expert care, support and advice. One resident spoken to said, “I came in here underweight and in a right state. I am now halfway through my programme and feel so much different and healthier”. The rehabilitation programme enables high levels of staff to be available daily to ensure the residents have support and time to discuss any issues in a group meeting or on a one to one basis. Comments from residents included, “Good counselling available”. And,” Always someone to talk to”. One staff member said, “We always have time to spend with the residents”. Good detailed information is provided to residents, which ensures that they are aware of and agree to all aspects of the treatment programme prior to admission to Pierpoint House. Residents spoke highly of the commitment and qualities of the staff, which have excellent communication skills and personal qualities, which ensures they
Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 6 carry out their role to a high standard. Residents spoken to said, “The staff are very understanding”. Another said, “They know how to treat us”. Residents spoken to said the food was very good and a choice is given ensuring they receive a balanced diet. Examination of menus, Observation of the kitchen area and food being prepared confirmed fresh produce and a selection of vegetables and fruit are being used. The chef said, “We always offer a choice and prepare home cooked meals”. One resident spoken to said, “The food is fantastic. I have gained weight since being here”. What has improved since the last inspection? What they could do better: 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. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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 Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the information required to make a choice about the home and are professionally assessed prior to admission onto the treatment programme. EVIDENCE: Examination of the Statement of Purpose and Service User Guide confirm they have recently been reviewed and outlines the admissions procedure and provides potential residents with clear guidelines to enable an informed decision to be made about admission to the home. Three resident files looked at confirmed the assessment format is detailed and comprehensive ensuring all the information is recorded. Professional assessments for this resident group are carried out prior to admission which ensure all care needs will be met on the treatment programme. Residents confirmed that restrictions on choice, freedom, services or facilities required by the treatment programme are discussed and records examined confirmed that people sign in agreement to such restrictions. One resident spoken to said, “The information about the treatment was good”. Another said, “Its tough but I was aware of that with the stuff I read about the home before I came”. One staff member spoken to said, “Residents know about the restrictions and routines before admittance with all the information provided”. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are helped to make decisions in line with their care plans; risk assessments and treatment programme and understand the restrictions are in their best interests. EVIDENCE: The records for three residents were examined and clearly described their health and welfare needs. Resident’s care was recorded with good risk assessments, reviewed through each stage of their individual programme. Each person had a daily activity programme in line with their treatment and included group counselling sessions, one to one meetings and health checks. All aspects of the residents care has been recorded daily ensuring the correct monitoring of each individual is informative and in line with their treatment. One resident spoken to said, “The routines of the home are helping with my problems”. Residents are involved in decision-making to a certain extent, within the structured framework of the treatment programme. Periods of free time are built into the daily programme. The homes rules and limitations are fully discussed and agreed before admission. Group meetings take place regularly, where residents make decisions within a risk assessment framework regarding
Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 10 free time and certain social activities. A resident commented, “Its restricted at times but I know its part of the treatment”. Each resident is required to read and sign a confidentiality policy statement and copies of these agreements were examined on records. Staff sign a confidentiality agreement as part of their terms and conditions of employment and visitors also sign an agreement regarding confidentiality. A member of staff said, “Confidentiality is important part of the routines of the home”. A resident said, “Its important to respect each others privacy”. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The treatment programme provides opportunities for personal development, and confidence to maintain positive relationships and make changes in the service users lifestyle. Meals are well managed and provide wholesome, healthy nutritious options. EVIDENCE: Discussions with the manager and staff confirmed they are aware of making sure individual lifestyles are reflective of their needs. This is achieved through recognising individual need and working through the treatment programme and ensuring support to achieve their aims of the programme. A resident spoken to said, “The sessions for discussion are helpful to look forward and carry on with my life”. Another said, “The staff are good at listening and supporting me”. A staff member spoken to said, “Its satisfying to see the residents development through the treatment so they can understand their problems and move on and make changes in there life”. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 12 Observation at the time of the inspection found the residents were on their daily routines ranging from group therapy meetings, out in the community and one to one sessions ensuring a variety of activities for each resident in line with there individual care plan. Staff spoken to said, “The resident’s daily routines can be discussed within the group meetings and their input can be implemented”. One staff member said, “We try and support the residents in their interests as long it is within the rules of the home”. Entries made on care plans confirmed staff had discussed with residents participating in activities and interests of their choice. The homes visitors’ policy includes certain restrictions, to maintain the treatment programme and reduce risks. The structured treatment programme forms the framework for daily routines, with guidelines regarding attendance and involvement. The Service User Guide clearly outlines any rules and restrictions, including what happens when rules are broken. Residents spoken to confirmed that they receive information regarding daily routines and the homes rules, expectations and restrictions before they are admitted. One resident said, “The information about the home made me clearly aware of what I was getting into”. A staff member spoken to said, “There is a lot of information available about the rehabilitation and detox programme for potential residents to make a choice if they think it will help them”. Observation of the printed menus, the kitchen area and discussion with the chef and residents found they’re to be plenty of fresh food available, a choice of meals and of a high quality to ensure the dietary needs of the residents are met. Comments from residents included, “Fantastic meals”. And, “I have never eaten so well”. Also, “At least we have a good choice and healthy options”. The chef spoken to said, “I make sure we have a healthy selection of fresh food and home cooked meals”. There was recognition of making sure residents privacy and dignity is maintained, so that residents feel they are respected. This was observed whilst walking around the home and the way staff talked to the residents and making sure doors are closed, and rooms are not entered until a response is made after knocking on the door. One staff member said, “We respect everyone as an individual”. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Physical and emotional health care needs are taken seriously and monitored ensuring health issues are met. EVIDENCE: Residents do not generally require support regarding maintaining their personal care. Any issue regarding hygiene or appearance would be addressed individually as part of a one to one sessions and care plan. Residents are encouraged to maintain a positive image by looking after their clothing, carrying out personal laundry tasks and keeping their bedroom clean and tidy. A staff member spoken to said, “We encourage the residents to look after themselves”. There are set times for getting up and going to bed, which is necessary for the running of the treatment programme. Residents receive full information regarding these rules prior to admission to the home. A resident spoken to said, “ We know the rules”. The function of the home enables excellent access to specialist healthcare services with qualified nurses available every day or night and the GP visiting three times a week with a facility provided should residents feel they need to talk in private. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 14 Medication practices were safe and good records had been kept ensuring residents health is maintained. A Member of staff said, “ Only trained staff administers medication”. The three medical records looked at were being accurately maintained to ensure the safety and protection of the residents. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Staff have a good knowledge and understanding of safeguarding adults issues, which protect residents from abuse. EVIDENCE: The home has a detailed complaints procedure, which is made available to all residents on admission and displayed in the Statement of Purpose and Service User Guide. One complaint since the previous inspection was received by the Commission and referred back to the home to investigate. Examination of the documentation confirmed this was dealt with appropriately. The home has a procedure in place for dealing with allegations of abuse. The registered manager and staff spoken to had a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. Residents have the opportunity to complain or make suggestions at the weekly team meetings to contribute to the effective running of the home. One resident said, “Any complaints or concerns can be talked about at the meeting”. Members of staff spoken to said, “It’s an opportunity to address any problems”. And, “Our National Vocational Qualification training (NVQ) covers abuse concerns”. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and tidy and some refurbishment has improved the premises ensuring the residents feel comfortable. Further redecoration and refurbishment would ensure the home provides a homely attractive environment in which to live in. EVIDENCE: A tour of the building found the home to be clean and tidy. Some improvements to the inside of the home with new carpets and some redecoration and provide pleasant surroundings. Further refurbishment is ongoing to bathroom, bedroom and communal areas. The manager said, “Gradually the work is being done”. A new facility to provide a private consulting room for GP visits has been completed so that residents can see the Doctor in privacy. The home employs a maintenance person and records are kept ensuring any problems with the building and fixtures are replaced or fixed. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by qualified and trained staff who have the skills and competencies for their roles. Recruitment procedures are robust to make sure residents are safe and protected. EVIDENCE: Training for staff is good, records shows the target of 50 of care staff to complete (National Vocational Qualification (NVQ) level 2 in care has been achieved. One member of staff said, “I found it to be helpful once they adapted the NVQ for our specialised role”. Examination of three staff files confirmed the recording procedures of the home are good. Staff records include, application forms, confidentiality statements, individual photographs, Criminal records Bureau (CRB), Protection of Vulnerable Adults (POVA) disclosures and references were in place to ensure the residents are protected. All checks had been completed prior to commencement of employment. To improve the recruitment procedure dates on the references received would evidence commencement of employment after they had been checked. Evidence of (POVA) disclosures are being undertaken, however good practice would be for each staff member to have this recorded in their individual file to evidence checks have been requested.
Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 18 Examination of staff records confirmed each member has an ongoing training record, discussion with personnel confirmed they had induction training when they started working for the home, carried out by the management and senior staff. New staff spend time in different parts of the Pierpoint service, in order to gain an insight of the whole treatment programme. At first staff complete a core programme of training, which includes first aid, health and safety, medication, food hygiene and fire safety. Staff commented that the training gave them an insight as to how the home operated and supported the residents. Comments from staff included, “The initial training was good”. And, “The management are always supporting us with any courses or training we need”. A resident spoken to said, “The staff seem to know what they are doing and seem well trained”. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the treatment programme is run in the best interests of residents. Health and safety of staff and residents are promoted ensuring they are protected. EVIDENCE: The registered manager has the necessary skills and qualifications required to support the staff and residents and enable the home to meet its stated purpose and objectives throughout the treatment programme. Both staff and residents commented on the support received. One member of staff spoken to said, “I love working here, the management team are always helpful and supportive”. A resident spoken to said, “Any problems and I know the manager is available to talk to”. Examination of records for residents confirmed they are comprehensive, well written and up to date ensuring the correct information is available throughout each stage of the treatment.
Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 20 Feedback from service users indicates that the treatment programme is well organised. Comments included, “Definitely helped me”. And, “I am glad to be on the programme”. Records show there are good quality assurance systems in place to seek the views of residents to impact on the general running of the home. Group and individual discussions take place, with these meetings giving opportunity for people staying at the home to voice any concerns, complaints or suggestions. Questionnaires are given to residents, inviting feedback regarding different areas of service provision including; meals, rules, group sessions and facilities. A resident spoken to said, “We do get a chance to air our views and are listened to”. Examination of records and information received from the manager confirmed regular tests to emergency lighting, fire procedures and extinguishers had been carried out ensuring the safety of residents and staff is maintained. Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 21 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 22 No 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. Refer to Standard Good Practice Recommendations Pierpoint House Nursing Home DS0000006070.V328590.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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
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