CARE HOMES FOR OLDER PEOPLE
Portelet Lodge 42 Westby Road Boscombe Bournemouth BH5 1HD Lead Inspector
Jo Palmer Unannounced 12 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Portelet Lodge Address 42 Westby Road, Boscombe, Bournemouth, Dorset, BH5 1HD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 398982 david@porteletlodge.fsnet.co.uk Portelet Care Ltd Miss Sarah Louise Joyner Care Home only 21 Category(ies) of MD(E) - 21 registration, with number DE(E) - 21 of places Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: In addition to registered places a day care service of up to 7 hours per day may be provided for two people in the categories MD(E), DE(E). Date of last inspection 02 Sptember 2004 Brief Description of the Service: Portelet Lodge is a care home registered with the Commission to provide personal care and accommodation for 21 people over the age of 65 years who have mental health needs. Portelet Lodge is registered under the company name Portelet Care Limited, one of whose directors is the responsible individual for Portelet Lodge. Sarah Joyner is the registered manager. Portelet Lodge is situated in a residential area of Boscombe, Bournemouth, and is a short walk from local shops and amentities and the sea front. Accommodation is provided over three floors, a five person passenger lift provides access between floors along with a central stairway. There are fifteen single rooms, eleven of which have en-suite facilities, and three shared rooms all with en-suites. On the ground floor there is a communal lounge and dining area and a conservatory opening up to the rear garden. The gardens are secure and provide seating for residents. The front of the home provides off road parking for 5 or six cars, parking on Westby Road is avaialble although limited. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection on 12th July 2005 lasted for three and half hours. Sarah Joyner the registered manager and David Lallana, responsible individual were present and provided necessary information, access to records and introduction to residents. The inspection was carried out as part of the routine schedule of inspection of this service. Some of the key National Minimum Standards were reviewed. The inspector spoke with six residents; two care assistants, Mr Lallana and Ms Joyner, toured the premises and examined relevant records. No visitors were present during the inspection. What the service does well:
Prior to admission, people’s health and welfare are assessed to determine if the home can meet their needs and they are issued with a contract detailing their rights regarding their time at the home. The right to complain is outlined in the Terms and Conditions of Residency and residents are assured their complaints and concerns will be listened to. Care needs are met through good planning and organisation and there was some indication of resident consultation although this needs to be more consistent. Staff have a systematic approach to planning how health and welfare needs will be met and there was good evidence of a multi-disciplinary approach to care delivery where this is necessary. Residents who were able to confirmed that they feel they are respected and their right to privacy is supported. Resident’s medication is well managed on their behalf with accurate recording storage and administration procedures in place. Residents at Portelet Lodge have varying degrees of dependency and complex needs and many are unable to make decisions and choices about their daily lives. Being heavily reliant of staff for decision-making, resident’s care plans detail their opportunities for leisure and recreational pursuits. This was a brief inspection but one where it was noted that staff were continuously present with residents in the lounge areas of the home providing personal and social care support as required. Residents confirmed that good meals are provided and that choices are available that suit their preferences. Records relating to meals in the home endorsed this.
Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 6 Procedures for managing complaints and protection are held in accordance with expected procedures, there have been no complaints or incidents reported to the Commission. All parts of the home seen were clean and comfortable, there was some evidence of redecoration and refurbishment in some areas. There are sufficient numbers of toilet and bathing facilities. Some resident’s confirmed that their bedrooms were comfortable and suitably furnished. There are sufficient staff to meet the needs of the residents and the needs of the home in relation to catering and domestic duties. Staff training opportunities are good resulting in an enthusiastic workforce with a commitment to meeting residents needs. The manager, Ms Joyner showed a commitment to the development and improvement of the service as well as showing a good understanding of the resident’s needs, and having a good relationship with residents and staff. What has improved since the last inspection? What they could do better:
Discussion with some residents and review of care files evidenced that care needs are met by staff in the home with due respect for their individuality, rights, choices and preferences. It has been recommended at this inspection that staff give further consideration to ensuring that where resident’s retain the capacity to make decisions, they are involved in their care planning processes and reviews. Where it has been assessed that they do not have the capacity to contribute, appropriate advocacy is documented indicating who has made decisions on behalf of the resident, this should indicate a multidisciplinary approach. A requirement of the previous inspection that has not been addressed must now be attended to as a priority regarding prevention of Legionella in the home. The registered persons must make arrangements for hot water to be stored at an appropriate temperature. A recommendation has also been repeated from previous inspections that the premises are assessed by a qualified person to establish the extent of the disability equipment required to meet the needs of service users.
Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 & 4. Standard 6 is not applicable Prior to admission, the needs of each prospective resident are assessed to ensure the home will be able to properly meet them. Residents are issued with a contract describing Terms and Conditions of occupancy, including the fees, at the point of admission to the home. The admissions process therefore provides prospective residents and their representatives with sufficient information for them to know that Portelet Lodge will be a suitable place for them to live. EVIDENCE: Standard 1, regarding information available to residents was not assessed although Mr Lallana confirmed that the Statement of Purpose and Service User Guide had not changed since the last inspection where it was evidenced that the standard was met. Examination of resident’s care files demonstrated that prior to admission, an assessment of need is undertaken to ensure the resident is suited to a placement at Portelet Lodge. Assessments seen contained information identifying the resident’s needs, where residents have assistance with their funding from a local authority, a copy of the care management assessment
Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 10 was available. Following initial assessment prior to moving to Portelet Lodge, residents undergo a further period of assessment on or shortly after admission where more detailed information is obtained regarding their needs. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The home offers a structured approach to planning how resident’s health and welfare needs will be met. Systems for resident consultation and participation in the assessment and care planning process are inconsistent although resident’s rights are respected and their right to privacy is supported through care delivery and relationships with staff. The systems for the administration of medication are good with clear and comprehensive arrangements being in place supporting resident’s mental and physical wellbeing. EVIDENCE: Care files examined demonstrated that a series of assessments are undertaken when the resident arrives at the home or shortly afterwards, these assessments detailed all health and welfare needs and had been reviewed regularly. Following the assessments, care plans are written providing an account of how each need is to be met by staff and any specific care intervention required. Care plans address all assessed need and demonstrate respect for the resident’s personal characteristics.
Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 12 On one set of care records examined there was no evidence of the resident’s participation or consultation in the assessment and care planning process, another file did evidence such consultation with the resident having signed the assessment indicating her knowledge of its contents. Caution is needed to ensure that where residents retain the capacity to make decisions regarding their lives in the home, that they are enabled to do so. However, residents spoken with who were able to confirm that their needs are discussed with them and they felt they were respected with regard to their choices about care delivery. Records of care provided a detailed account of the activities and daily routines of each resident detailing their life in the home and show a good level of support from the home in assisting contact with other health care professionals including district nurses, GP’s, psychiatrists, social workers, and community psychiatric nurses. Staff spoken with enthusiastically spoke of their roles in care delivery and managing resident’s needs and stated that they had plenty of opportunities to discuss resident’s needs with senior staff in supervision and on a day-to-day basis. Residents spoken with who were able to comment confirmed that they are able to make appointments, or staff make appointments on their behalf with doctors, opticians, dentists etc as required. Records of medication administration and medication stocks were examined and demonstrated that good practice is adopted. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Social, cultural, and recreational activities are dependent on individual resident’s capacity for involvement. Residents are supported in maintaining contact with their friends, families and the local community. Care plans address residents social and leisure needs and how these are to be met and although the resident’s agreement with care plan outcomes is not always indicated, care records demonstrate an implicit understanding of individual preferences and choice. Dietary needs of residents are well catered for with a balanced and varied selection of food available that is well presented and meets residents’ tastes and choices. EVIDENCE: Assessments and care plans address residents social, cultural and recreational activities and daily records demonstrate the manner in which staff support them in carrying on with their social arrangements. Some residents at Portelet Lodge retain the ability to go about their daily business with minimal support whilst others are less able to communicate their needs and rely on higher levels of staff intervention. Two notice boards in the entrance to the home provide photographic testimony to a range of activities the home has engaged residents in including parties, outings and other social events. Residents spoken with who were able to comment confirmed that they enjoy trips out in
Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 14 the mini bus and that staff in the home provide sufficient stimulation throughout the day. In the lounge area after lunch, the atmosphere was relaxed, with staff present who were engaging with residents in a considerate and courteous manner. A set midday meal is provided from a menu that changes every three weeks. Records seen demonstrated how resident are able to choose an alternative if they do not like, or want the set meal. Residents are informed of the main meal and alternatives available by staff and a notice board in the dining area advertises, with pictures the meal of the day. In the evening, a light meal is provided dependent on residents choice, records demonstrated that a variety of sandwiches, soups, beans/eggs on toast, chicken nuggets, corned beef hash etc are served. All meals are generally taken in the dining room and although staff confirmed that residents could have their meals in their rooms if they prefer, most choose to use the dining area. Residents spoken with confirmed that meals were good, appetising and plentiful. Ms Joyner assured that fresh ingredients are used and most meals and desserts are home cooked. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Residents are provided with written assurance in their Terms and Conditions of Residency document that any concerns or complaints will be listened to and taken seriously. Arrangements for protecting residents from possible risk of harm or abuse are satisfactory. EVIDENCE: Mr Lallana confirmed that the home’s complaints procedure is contained in the Service User Guide, this was not examined on this occasion; a copy of the Terms and Conditions of residency that is issued to each resident on admission also contain details of the process of making a complaint. Mr Lallana and Ms Joyner confirmed that no complaints had been received. Policies are in place with procedural guidance for staff informing them of the action to be taken in the event of any incident of abuse being alleged or reported. Staff spoken with confirmed knowledge of this procedure, which is held in accordance with local authority guidelines on abuse. One incident of alleged abuse was reported although on investigation the local authority adult protection team did not pursue the matter. There have been no other incidents reported. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 21, 22, 23, 24 & 25 Residents live in a safe, comfortable, clean environment with their own belongings around them. Bedrooms and bathrooms provide sufficient room for residents and their privacy is upheld by staff practices. A lounge and dining room area provides sufficient space for residents and there is safe access to the gardens. Hot water temperatures are not regulated thereby compromising resident’s welfare and the need for specialist equipment has not been assessed potentially restricting some resident’s movement and independence around the home. EVIDENCE: The interior décor of the home, the hallways and corridors are satisfactorily decorated, furnished and carpeted. There was evidence of some re-decoration. Residents are able, if they wish, to bring in items of their own furnishings subject to suitability, some rooms were more personalised than others. Bathrooms, showers and toilets are sited around the home conveniently for residents, additionally; eleven of the fifteen single rooms, and all three shared rooms have en-suite facilities.
Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 17 Communal space in the home is well used by residents and provides comfortable surroundings where residents can enjoy each other’s company. A conservatory to the rear of the home provides additional seating and a television; the conservatory is well protected from excessive light and heat with a tinted roof enabling the room to stay at a comfortable temperature. The home was well ventilated, being a hot summer day, many of the windows were open and electronic extractor fans are sited in bathrooms and toilets where there are no external windows. Domestic lighting is provided throughout the home and there is sufficient natural light. The home is centrally heated and each area has a radiator, these have not been guarded although risk assessment have been undertaken in respect of the risks posed to individual residents from accidental scalding. Previous inspection reports have recommended that Mr Lallana arrange for an assessment of the premises in order to establish the extent of the disability equipment necessary to meet resident’s needs and ease access around the home. The recommendation has not been addressed and is repeated here. The inspector provided Mr Lallana with information on where to find an occupational therapist who may undertake this form of assessment. Hot water in the home is distributed at a temperature that prevents accidental scalding although a requirement of the last inspection has not been addressed with regard to protection against legionella. An inspection of the water systems in the home by the water board evidenced that water is distributed at around 50 degrees where it is required to be distributed at 60 degrees. Mr Lallana confirmed that he has arranged for the appropriate works to be carried out although as a lengthy and arduous task, work will not be completed until December 2005. Risk assessments have been carried out for residents where it is considered they are at risk of accidental scalding, when requirements concerning Legionella have been addressed, these risk assessments must be reviewed in light of the fact that water will be distributed at 60 degrees and resident’s baths should be drawn at around 43 degrees. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 There is consistent deployment and number of available staff with clearly defined roles to meet the needs of the residents. Staff commitment to training is good and ensures residents are in safe hands at all times. EVIDENCE: Staff rotas demonstrate that there are four care staff on duty during each day time shift and two at night. Additionally, the registered manager, Ms Joyner is on duty for six shifts per week, four of which are dedicated to management time. Mr Lallana as the responsible individual for Portelet Lodge is also present within the home at various times throughout the week to support the manager, staff and residents. Two care staff have attained an NVQ level 2 award; one has attained level 3. Two further care staff have overseas nursing qualifications; not registered to provide nursing care, Portelet Lodge employs these staff as care assistants and have evidence that their qualifications exceed the expectations of an NVQ. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 & 37 The management arrangements of the home support good care practices for residents and the manager has a good understanding of her responsibilities in the care home and in the legal context of the home’s registration. EVIDENCE: Ms Joyner is in the process of finishing her management qualification, which she hopes will be completed within the next month. Ms Joyner demonstrated her fitness to be in charge of the home throughout the inspection with her knowledge of resident’s needs and discussion about the way in which these are managed in the home and with good understanding of staff management in respect of their care duties and roles. Examination of one set of care records evidenced an incident that had been managed well by Ms Joyner and Mr Lallana and had been satisfactorily resolved. The incident concerned an episode of particularly challenging behaviour presented by the resident. Ms Joyner’s understanding of the process of managing the situation were well grounded and effective.
Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 20 Staff and residents spoken with talked of the good communication in the home with Ms Joyner and Mr Lallana being available for support throughout the week, regular staff meetings and supervision. Residents who were able confirmed that they felt comfortable in relations with staff and stated that if they had any concerns, they would be able to speak to staff. Of those records examined, all were well maintained and up to date, were held securely and were written in a manner that was both respectful of the residents as individuals and informative concerning their lives in the home. Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x 3 3 2 3 3 1 x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x 3 x Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 25 Regulation 13 Requirement It is required that water is stored at a temperature of at least 60 degrees centigrade and distributed at 50 degrees centigrade minimum, to prevent risks from legionella. Previous time-scale 01.04.05 Timescale for action 31.12.05 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. Refer to Standard 7 Good Practice Recommendations Where assessments have identified a residents rights and abilities to make decisions regarding their care, their contribution to the assessment and care planning process should be documented. Residents relatives or representatives cannot unilaterally give consent on their behalf. Where residents lack the capacity to make decisions, a multi-disciplinary decision making process should be documented. It is recommended that the Portelet Lodge premises be assessed by suitably qualified persons including an Occupational Therapist. 2. 22 Portelet Lodge D55 S53933 Portelet Lodge V227762 120705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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