CARE HOME ADULTS 18-65
RNID Mulberry House Mulberry House 70 Lichfield Street Walsall West Midlands WS4 2BY Lead Inspector
Lesley Webb Announced Inspection 24th January 2006 09:30 RNID Mulberry House DS0000020840.V272373.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 RNID Mulberry House DS0000020840.V272373.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. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service RNID Mulberry House Address Mulberry House 70 Lichfield Street Walsall West Midlands WS4 2BY 01922 615218 01922 615218 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) Royal National Institute for Deaf People Caldmore Housing Association Mrs Christine Violet Beckett Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6), Physical disability (6) of places RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No number division between categories Date of last inspection 26 July 2005. Brief Description of the Service: Mulberry House offers residential placements for up to six service users who may have a mental disorder (excluding learning disability or dementia) and who may also be deaf or hard of hearing. The premises are made up of 2 selfcontained bed-sits and 4 flat, set within a large detached property. The offices, kitchen and sleeping in room are attached to, but are separate from the main house. The 4 flats consist of a bedroom, sitting room, kitchen and bathroom/shower. There is a separate bathroom on the ground floor for service users who prefer to bath rather than shower. Also on the ground floor is a shared sitting room leading directly onto the patio. The home has a goodsized garden and off road parking to the rear of the property. A laundry is fitted with a coin operated washing machine and dryer. All of the service users sign to say they agree to any profits form this facility to go into the service users social fund. The home is located near to the centre of Walsall, close to many shops and facilities. There is a main road to the front of the building with many bus routes to other parts of the West Midlands and the local Arboretum faces the home. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. All the service users and some of the staff at Mulberry House are either deaf or hard of hearing so the inspector arranged for an interpreter to accompany her on the announced inspection. They arrived at 9.30am and spent 3 hours interviewing in private all 5 service users in order to obtain their views and opinions on service provision and life at the home. The interpreter then left with the inspector remaining at the home until 6.30pm. During that time the inspector interviewed 3 members of staff, observed practices, toured the building and looked at records before giving feedback to the registered manager. As in previous visits the home the inspector was satisfied that the home offers a very good service and would like to thank everyone for his or her cooperation and assistance during the visit. What the service does well:
One of the main aims of Mulberry House is to rehabilitate so that service users can move to independent living in the community. All practices observed during the inspection demonstrate that staff have excellent knowledge and understanding of this, supporting service users to become independent in as many aspects of their life as possible based on each persons individual capabilities. Programmes are in place to support service users to manage their own meals including shopping, preparation, cooking and diet, all of which are undertaken on a one to one basis. In addition to this service users are supported to self medicate based again on assessments of capability. Service users also informed the inspector that staff support them with relationships. This support includes arranging transport, writing letters and acting as advocates if required. As one service user explained, “the staff help keep in touch with friends. They help me with information, I’m not good with letters so they help me with this”. Another service user explained that staff had taught him to use the text facility on his mobile phone in order that he can stay in touch with people. Training and development offered to staff is excellent at this home. Records and interviews with staff confirm that an abundance of training and support is offered, resulting in a knowledgeable workforce that actively promotes service users rights and responsibilities. As one member of staff explained, “training that I have undertaken has made me more aware of my role in supporting service users. It’s a big part of my job to show service users they are capable of doing things for themselves. I am here to support them, it might mean trying different approaches for each service user but everyone has potential and when they achieve something new it helps increase confidence”.
RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 6 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. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 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 RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed at last inspection. EVIDENCE: RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed at last inspection. EVIDENCE: It was noted by the inspector that previous requirements relating to care plans and residents meetings have now been met in full by the home. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 10 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): 15, 16 and 17. The home is excellent at supporting service users to have personal, family and sexual relationships resulting in enriched lives for people living at the home. The rights and responsibilities of services users are well managed in this home, creating an inclusive atmosphere for the people who live there. Generally the management of meals in this home is good, with ample evidence that service users exercise choice and control over what they eat. Further work must be undertaken to ensure the nutritional needs of service users are fully understood by staff. EVIDENCE: RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 11 The inspector found that staff support service users to maintain family links and friendships inside and outside the home, subject to individual’s choice and care plans / contracts. The service users choose whom they see inviting visitors either to the communal lounge or if privacy is required their flats/bed sits. Due to the service users who live at Mulberry being so independent many meet people and make friends with others who do not have a disability. Staff confirmed to the inspector their understanding of supporting people to develop and maintain intimate personal relationships with people of their choice, and gave examples of how they had put this knowledge into practice. For example one member of staff stated, “It depends on what the service user wants. If they do not want contact with their family we have to respect that. If needed we arrange home visits, transport, staffing. Also we remind them of birthdays, pass on messages, act as a go between if needed”. Another member of staff explained, “we try to encourage friendships by using local pubs so service users can make new friends or arrange transport if needed”. All service users that the inspector spoke to confirmed these comments, all of which stated that staff help them when needed. The service users take responsibility for housekeeping tasks, cooking, cleaning their own rooms and laundry. There is unrestricted access to the communal parts of the home. Each of the service user flats have flashing lights connected to the doorbell in order that staff only enter after gaining an individuals permission. All service users have keys to their flat, front door of the building and rear, with staff using a separate entrance to the building. Service users informed the inspector that routines are flexible within the home and staff respect their rights. For example one service user stated, “This is the first place that I have had my own keys. Staff have a key as well but only use it in emergencies. They will bell before coming in. I also open my own mail. If I don’t understand it the staff will explain and help me”. All the flats and bed sits within the home have their own cooking facilities as aids to independence, with service users preparing and cooking their meals on an individual basis. Staff assistance is given depending on each service users needs. In addition to this there is a communal kitchen where meals are prepared and cooked for group social activities. . Mealtimes are relaxed, unrushed and flexible to suit service users’ activities and schedules. Evidence was supplied to the inspector that demonstrated that menus meet dietary and cultural needs; however further work is required to ensure staff are aware of nutritional assessments in place for individuals because when interviewed noone was sure if they existed and/or the contents. Care plans are completed that action goals for greater independence or knowledge for shopping, preparation and cooking of meals. These are monitored and reviewed as part of the rehabilitate process. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 12 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): 20. In the main medication at this home is well managed and promotes service users independence. EVIDENCE: The home has comprehensive policies and procedures for all aspects of medication apart from that of secondary dispensing, despite this being practiced within the home. The inspector instructed that this practice must cease with an alternative system put in place that safeguards everyone at the home. All other medication and records viewed by the inspector were found to be in order. Since the last inspection the majority of staff have enrolled on accredited medication training to enhance other medication training they have previously undertaken. The home uses the Boots Monitored Dosage System for prescribed medications. As part of this service the pharmacist visits the home every three months to complete audits and offer advice. All service user files sampled by the inspector contained medication risk assessments and consent to either self medicate or receive assistance from staff. One service user informed the inspector that he is planning to move in the future and would be living in an independent environment. He stated because of this staff had supported him to self medicate explaining, “staff have helped me, taught me to check sugar levels, its all about balance. I keep my medication in my flat, private”.
RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The home has a good complaints system with evidence that service users views are listened to and acted upon. Staff’s knowledge of adult protection is excellent and helps protect service users from abuse. EVIDENCE: A previous requirement to ensure comprehensive records are maintained of issues and complaints made by service users has now been met by the home. Records viewed demonstrated that investigations are completed along with a record of actions taken. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 14 When interviewing service users everyone was able to name someone they felt comfortable to talk to if they wanted to make a complaint or if unhappy about treatment. Compliments made about staff include, “she is good, teaches me things, helps me, is easy to talk to” and “staff sort problems, are very good”. The home has comprehensive policies and procedures for all aspects of abuse. These documents work in conjunction with the local authority vulnerable adults procedures. Discussions with staff demonstrated to the inspector their knowledge and understanding of abuse and their role to protect, for example one member of staff stated, “when they are out in the community by themselves it is difficult but we encourage to carry identification with Mulberry House information on it. When at home we encourage to discuss concerns both in private and in the weekly residents meetings. We document and monitor everything, look for signs such as withdrawal, behaviour changes”. The inspector was also pleased to find that since the last inspection the majority of staff working at the home have undertaken adult protection training to further support their knowledge in this area. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 15 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 and 30. Generally the standard of the environment within this home is adequate, providing service users with a comfortable place to live. Some infection control measures are not in place and have the potential to place service users at risk. EVIDENCE: Two requirements identified in previous inspections relating to the premises remain unmet. The exterior of the premises is still to be redecorated and requirements made by the fire department in 2004 have not been acted upon. Caldmore Area Housing Association (the organisation that owns the property) is disputing the need for some of the fire requirements to be acted upon. The inspector is concerned that the requirements have not been actioned in full and informed the manager that she would be contacting the fire service to see what action will be taken next but until such time that the fire department state that work is not required actions within the report still stand. After touring the premises the inspector found that generally it is maintained to an acceptable level. Attention is required to: * Investigate the watermarks on the ceiling in the staff sleep-in room and repair the damaged wallpaper to ensure the building is being appropriately maintained.
RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 16 * Repaint the yellow lines in the garden and to mark steps at the front of the building so that people are aware of various locations of steps. * Paint the downstairs bathroom as it is stained and worn in appearance. The manager states that the communal kitchen is going to be refurbished this year and a new vehicle is being purchased. When looking around the building the inspector found that the training room is used for storage with the manager stating that service users choose not to use this facility. The inspector recommends that this room be evaluated with alternate uses investigated. The home has a separate laundry room that has a washing machine (with disinfection programme), hand washing sink and dryer. Upon inspection of this facility the inspector found that no liquid soap, paper towel or personal protective equipment was available for use. All policies and procedures relating to the control of infection were found to be located in the main office. The inspector strongly recommends that copies of these be displayed in the laundry as aids to education for service users (the majority of whom do their own laundry). RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35. Generally recruitment practices are acceptable, however improvements will ensure further protection to people living at the home. Training and development of staff is excellent at this home resulting in a knowledgeable workforce who have the appropriate skills to meet the needs of service users. EVIDENCE: It was noted by the inspector that a previous requirement to ensure all staff files contain 2 forms of identification is now met. A previous requirement to maintain medical declarations for staff is still unmet with the manager stating that she had been informed by the human resources department of RNID that they do not have these for any employees. When discussing references for staff that have been disciplined the manager was unsure of the organisations stance in relation to disclosing this information. The inspector instructed that information regarding this must be forwarded to CSCI for consideration. The home should be commended for its training and development systems and structures in place. A Senior member of staff is responsible for ensuring the homes training and development programme is maintained and the inspector found that all staff have individual training and development assessments completed that not only detail mandatory training needs but also training and development requirements that are linked to service users individual needs and care plans. All staff receive structured induction and foundation training that meets Sector Skills specifications, with the appropriate records
RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 18 maintained. The National Minimum Standards state that staff should receive at least five paid training days per year, however at Mulberry House staff receive payment for all training they attend. Courses that staff have attended include bereavement, risk assessment, challenging behaviours, autism and alcoholism. Staff that were interviewed confirmed the organisations commitment to providing training and development, for example one member of staff stated, “everyone does core skills and training specific for your own role. Training is discussed in supervision and appraisal. This year we have been given even more opportunities to undertake training. The manager is really good at sorting training”. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42. Quality assurance systems are not based on the views of service users and their representatives and therefore have no value to the people who receive the service. Generally health and safety is well managed in this home, creating a safe place for service users to live. EVIDENCE: No progress has been made regarding requirements identified in previous inspection relating to further development of the quality assurance systems within the home. Although the inspector could find no evidence that this is having a detrimental effect on service provision, the manager was instructed that the requirements must still be addressed to further enhance the quality monitoring systems presently in place and to demonstrate that a systematic cycle of monitoring, review and improvement takes place. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 20 The inspector was pleased to find that the majority of staff working at the home hold up to date fire, first aid, food hygiene, manual handling, health and safety and infection control certificates. Safe working practice risk assessments were found to be in place and all accidents, injuries and incidents were found to be recorded and stored appropriately in accordance with the Data Protection Act. When looking at the fire risk assessment the inspector was concerned that it was not sufficiently detailed and did not take into consideration the unmet requirements made by the fire department in 2004. The inspector said that she would liaise with the fire department regarding this but that individual assessments for each service user must be implemented whilst this is being investigated. COSHH data sheets were found to be in place for all substances used in the home however risk assessments for products were not available. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 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 X 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 4 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X X 2 X X 2 X RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 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 YA17 Regulation 16(2) Requirement The manager must be able to demonstrate that everyone working at the home is aware of the existence of nutritional assessments and their contents. Secondary dispensing of medication must cease, with an alternative monitoring system implemented. A policy relating to secondary dispensing must be implemented. The exterior of the premises must be redecorated – Requirement originally made January 2004. The home must address all requirements made by the fire department – Requirement originally made August 2004. The home must investigate the watermarks in the sleep-in room and make any necessary repairs. The yellow lines in the garden must be re-painted and steps at the front of the building painted. The downstairs bathroom must
RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 23 Timescale for action 30/03/06 2 YA20 13(2) 25/01/06 3 YA24 16(1) 30/03/06 4 YA24 16(1) 30/03/06 5 YA24 16(1) 30/03/06 be redecorated. 6 YA30 13(3) Liquid soap, paper towels and personal protective equipment must be provided in the laundry room. All staff must sign a declaration stating they are fit for the role they undertake – Requirement originally made July 2005. CSCI must be notified in writing of RNID’s stance in relation to disclosing disciplinary information when reference requests for staff are sought. There must be an annual quality assurance development plan for the home – Requirement originally made January 2004. An annual audit of all quality assurance systems must take place with outcomes of the audit linked to the review of the development plan – Requirement originally made January 2005. The views of families, friends and stakeholders in the community must be sought as part of the quality assurance system – Requirement originally made January 2005. A written policy and procedure for quality assurance must be devised and implemented – Requirement originally made January 2005. Individual assessments of risk must be completed for each service user and incorporated into the homes fire risk assessment. The fire risk assessment must
RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 24 25/01/06 7 YA34 Schedules 4,6 17(2) 30/03/06 8 YA34 01/02/06 9 YA39 24 30/03/06 10 YA42 13 01/02/06 include phased evacuation. Risk assessments must be completed for all COSHH products. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA24 YA30 Good Practice Recommendations It is recommended that the disused training room be evaluated with alternative uses investigated. It is strongly recommended that policies and procedures relating to the control of infection be displayed in the laundry as aids to education for service users. RNID Mulberry House DS0000020840.V272373.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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