CARE HOME ADULTS 18-65
Rosedale Rosewood Bungalows 5 - 7 Flaxton Street Hartlepool TS26 9JY Lead Inspector
Jean Pegg Unannounced Inspection 20th November 2007 10:30 Rosedale Rosewood Bungalows DS0000021756.V355276.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 Rosedale Rosewood Bungalows DS0000021756.V355276.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. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rosedale Rosewood Bungalows Address 5 - 7 Flaxton Street Hartlepool TS26 9JY 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) 01429 269249 F/P 01429 269249 www.c-i-c.co.uk. Community Integrated Care Mrs. Michelle Butler Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD, maximum number of places: 6 The maximum number of service users who can be accommodated is: 6 30th January 2007 Date of last inspection Brief Description of the Service: Rosedale and Rosewood are two semi-detached bungalows that are owned and operated by Community Integrated Care (CIC). Together they are registered to provide care and accommodation for up to 6 people with learning disabilities. Rosewood and Rosedale are modern purpose built bungalows that provide single rooms for all residents; each bedroom has its own wash hand basin. Each bungalow has three bedrooms, a kitchen, a lounge, a dining room, a bathroom with a shower and toilet and a separate toilet. The bungalows have good-sized gardens and a car parking area. They are situated close to local bus routes. This allows easy access to the town centre of Hartlepool. There are also some smaller shops near to the home that sell more convenience items. Fees at the time of inspection were £1007.05 per person per week. These fees do not include personal items, toiletries and papers and leisure activities. Current fees and charges should always be checked with the manager. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection visit took place over two days, the 20 and 21 November 2007. To help with the inspection process we sent out questionnaires to the people who live and work at the home, their relatives and care managers. At the time of writing this report we have received four surveys back from people who live at the home and two from their relatives. Before we visited the home we asked the manager to fill in an Annual Quality Assurance Assessment form (AQAA). We used the information on this form to help us plan what we did when we visited the home. During our visit we spoke to all of the people who live at the home and seven people who work at the home. We also looked at records kept in the home as well as looking around the two bungalows to see if they were in a good state of repair. What the service does well:
The people who live at the home have their needs assessed. They are encouraged to make choices; take part in activities that they enjoy and live a nice lifestyle. One person told us “I have days where I have a timetable and days where I have free time.” People have their health care and emotional needs met. People are protected from abuse through the home’s polices and procedures that staff are trained to follow. One person who worked at the home told us “We have no complaints, we have a close relationship with service user parents.” The home is nicely furnished, decorated, homely and clean. The people who work at the home are offered training to do their jobs. The home usually has enough staff on duty to do most things with the people who live at the home. The home is managed well and takes into account the needs and the wishes of the people who live there. In our survey we asked relatives what the home did well. These are some of the things they said. “They look after my relative very well. They get to go to places and they love it. They are happy and so I am happy too.” “All I can say is that my relative is very happy and well looked after and is eager to go back when they have had a weekend home.” Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Rosedale Rosewood Bungalows DS0000021756.V355276.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 Rosedale Rosewood Bungalows DS0000021756.V355276.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&5 People who use the service experience good quality outcomes in this area. The people who live at the home have their needs assessed. The people who live at the home are given contracts that show how much they will be charged for the care they receive. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The records we looked at showed that people’s needs were assessed. The people who work at the home and other health care professionals monitor these needs. The areas assessed cover a range of needs including health, personal social, leisure and financial interests. The people who live at the home have had new contracts issued since October 2007. These contracts detail the charges that will be made and how they are broken down. Costs and responsibilities for payment are identified in the contracts. Rosedale Rosewood Bungalows DS0000021756.V355276.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 & 9 People who use the service experience good quality outcomes in this area. The people who live at the home are encouraged to make choices and take part in activities that they enjoy. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: We gained information by observing the people in the home and by talking to them. We were able to compare this information with what was written in the individual care plans. It was possible to determine that in general the people who live at the home were able to influence what was written in their care plans and that their individual choices and preferences were reflected in those care plans. The two relatives that returned surveys told us that they felt that the care home “always” met their relatives’ needs. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 10 Form the information that was written in the care plans there was evidence of care managers acting as advocates for the people who live at the home where some decisions were needed about health care. We noticed that the people who live at the home were able to make some everyday decisions for example taking part in activities or simple choices about food and clothing. The manager told us that the people who live at the home also attend staff meetings. The people who live at the home also have regular individual discussions with the people who work at the home. These people are known as key workers. Different topics are planned for each one to one session and these are recorded in the care plans. All of the people who live at the home attend the “Inclusion Group”. This group aims to get people involved in mainstream social and leisure activities. In our survey we asked the people who live at the home “ Do you make decisions about what you do each day?” Three said “Always” and one person said “sometimes”. These are some of the things they told us “I have days where I have a timetable and days where I have free time.” And “Yes I ask if I want to go out or do something” We also asked “Can you do what you want during the day; the evening and at the weekend?” All four people said yes but that it “Depended on staffing levels and what other residents are doing” Risk assessments are written as part of the care plan and risk management strategies are identified specifying what help is needed to support the people who live at the home. The people in the home attend a variety of activities for example: two are members of a walking group, two attend a day centre full time and one person attends the local college for two days a week. Some people also attend Pony World. During our first visit one person was going out shopping with a member of staff, during our second visit three people had gone to MacDonald’s for tea and had brought ice creams back for the three who decided that they did not want to go. Rosedale Rosewood Bungalows DS0000021756.V355276.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 & 17. People who use the service experience good quality outcomes in this area. The people who live at the home take part in different activities of their choice and live a lifestyle that suits their needs. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The people who live at the home take part in a variety of different activities but this is sometimes limited due to staff availability. We were told that the people who live at the home visit the local pub and have formed friendships with other locals who go there. The bungalows are situated in the local community but their immediate neighbours are mainly other care type establishments. All local amenities including the town centre are within walking distance of the bungalows.
Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 12 Four of the people who live at the home visit their families on a regular basis. Some of the people who live at the home talked about their relatives and staff told us that some people talk to their relatives over the phone. The only visitors to the home tend to be family members or people employed in the care sector. In our relative survey we asked “does the care home help your relative keep in touch with you” and “Are you kept up to date with important issues”. Both relatives replied “always” Individual responsibilities are recorded in the support plans but for many these are limited by individual skills and ability. The people who work at the home demonstrated a respectful attitude towards the people who live at the home during our visits. The people who live at the home were relaxed in the company of the people who work at the home. The manager told us that a dietician visits every six months to monitor the diet of two people in particular. One person has a liquidised diet due to swallowing problems. The manager confirmed that people’s weights are monitored each month and we saw a set of scales in the bathroom. The dieticians check the menus. When we opened the fridge we saw that food had been labelled with the date it had been opened. There was evidence of a variety of food for people to eat in the cupboards, fridge and freezer. During our second visit, one person showed us some cakes they had made that day. We were told that the menus are flexible and can be altered depending upon what people want. The home has been awarded four stars by Tees Valley Environmental Health. Rosedale Rosewood Bungalows DS0000021756.V355276.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 & 20. People who use the service experience good quality outcomes in this area. People have their health care and emotional needs met in an appropriate manner. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The care plans show how much help a person needs to assist them with their personal care. Prompts about hand washing were observed whilst we were there. Daily records are completed three times a day for each person. They include records of meals taken, moods and emotional states and leisure activities taken part in. The records we read provided a good account of how each person had spent their time. The care plans we saw included records of visits to health care practitioners. The reasons for the consultation or visit were also recorded along with the outcome of the visit. Individual records of medication were also kept in each person’s file. The staff we spoke to could relate to the individual moods of the people they cared for and the causes for any upset. The people who worked at
Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 14 the home were not afraid to offer acceptable physical contact and comfort to individuals who were upset. The home has appropriate facilities in place to keep medication safe. None of the people who live at the home administer their own medication. We checked the medication administration sheets and medicines held on the premises. The manager described the procedure that staff follow in the home for ordering, recording, storing and administering medication. The process was satisfactory and all records were available to see. The manager confirmed that all staff had completed the Safe Administration of Medicines Course and she was in the process of obtaining copies of all of their certificates as evidence of this. We were shown copies of observations checks that had been made to check people’s competency when giving out medication. Rosedale Rosewood Bungalows DS0000021756.V355276.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 & 23 People who use the service experience good quality outcomes in this area. People are protected from abuse through the home’s polices and practices although some areas could be improved to make sure that there are firmer controls in place to prevent possible financial abuse. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: In our survey we asked people “Do you know who to speak to if you are not happy?” three people said “Yes” They told us “I would speak to Michelle” and “I would tell the staff.” We also asked “Do you know how to make a complaint?” we were told “Staff would assist me in going through the complaints procedure”; “I would ask staff to help” and “Yes I tell any member of staff if I am not happy I shout and get angry”. Three people told us that they thought that staff “always” treated them well. One person who worked at the home said “We have no complaints, we have a close relationship with service user parents.” The manager confirmed that there had been no complaints made since the last inspection visit. The manager confirmed that staff had access to and had undertaken training to ensure the protection and safety of the people who live at the home. The manager was able to tell us the correct actions she would take if abuse were suspected in the home. The manager also confirmed that staff had completed training in breakaway techniques. We looked at the records held for peoples’ finances and recommended that the manager makes sure that where property
Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 16 is purchased on behalf of the people who live at the home that clear records are kept of these transactions. We also recommended that where the individual does not have the capacity to give consent, third party agreements are obtained for those purchase. Some records were better than others for recording this information. We also recommended that clearer records of the property that belonged to people were kept for each individual. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience good quality outcomes in this area. Some improvements to maintenance were noticed in the home. Some bad practices were reported to the Fire Service Department who agreed to deal with the issues to improve fire safety in the home. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: We were taken to look around the two bungalows and some people gave us permission to look in their rooms. Each room we saw was decorated in a different style and had of evidence of personal possessions in the rooms. The bungalows were furnished in different styles and were very homely and clean. The bathrooms were spacious and equipped with an island bath, shower and toilet and wash hand basin. Thermometers were seen in the bathrooms and records of temperatures were kept in the bathrooms. The external grounds were tidy and pleasant to look at. During both visits we noticed wedges being
Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 18 used to keep communal room doors open. This was discussed with the manager and door guards recommended. The Fire Service was informed the next day and they agreed to deal with the matter under the Fire Safety Reform Act. All work required during the last inspection visit had been completed and evidence of this was available in the home. This work included improvements to the fire alarm system and electrical work. From the surveys that we got back four people said that the house was “always clean.” The bungalows have a shared laundry that is equipped with washing machines and dryers sufficient to cope with the laundry of the six people who live in the bungalows. There were no unpleasant odours noticed during either of our visits. Recommendations from the last inspection visit had been followed in that communal wash areas had been provided with liquid soap and paper towels for hand washing as part of good infection control procedures. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 People who use the service experience good quality outcomes in this area. Staff are provided with training opportunities but records of training could be better to show what training people have done. Staffing levels are acceptable but could be improved to ensure that staff do not have to work additional hours to provide cover and to ensure that one to one activities with the people who live at the home can always take place. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Eleven of the thirteen staff employed at the home have completed a National Vocational Qualification in Care at level two. The home currently has two staff on long-term sick, which means the other staff are covering to ensure that sufficient staff are on duty. Bank staff are also employed to ease the situation. The home aims to have three staff on duty during the day and four staff during the evening when most people are in and one waking and one sleeping staff member during the night. From what
Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 20 we saw and were told by the people who live and work at the home, staffing levels can sometimes impact on what people are able to do and sometimes compromises will have to be made. The staff records we looked at showed that the appropriate pre employment checks are completed and employment records are held. The home employs both male and female staff and some staff commented on how rotas were flexible to support a work life balance. The manager has a training matrix that identifies the training that staff need to do. The staff records that we saw did not all have copies of certificates in place. These certificates would confirm that the person had successfully completed some important training for their job. The manager said that she had asked staff to provide copies of certificates and that if they were unable to do this then she would require them to undertake the training again. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience good quality outcomes in this area. The home is managed well and takes into account the needs and the wishes of the people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The registered manager has a National Vocational Qualification in Care at level 3 and she is halfway thorough her level 4 in care. She also has the Registered Managers Award. She has three years experience as a registered manager and has worked in other care settings. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 22 We saw some ‘stakeholder surveys’ that had been completed by five relatives for the year 2007. The relatives made some very positive comments about the home. We also saw minutes of meetings that included both the people who live and who work at the home. An area manager visits the home each month to make checks on the quality of the care provided by the home. Copies of these reports were seen. We looked at some safety and maintenance records for the home including the Fire Record file and Fire Officer report from May 2007. The file contains a copy of the fire evacuation procedure and records of tests. These records were up to date. A new fire alarm system was installed in May 2007. The Environmental Health Officer last visited the home in 2005. General work risk assessments were last reviewed in September 2007. These assessments included a number of work areas including work-based stress. We did notice wedges were being used to prop doors open. This information was passed onto the Fire officer who said they would deal with this issue under the Fire Safety Reform Act. Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 23 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 3 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 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 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 Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 24 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 YA24 Regulation 23 (4a) Requirement The provider must ensure that they meet the requirements of the Fire Officer and stop the use of door wedges in the home. Timescale for action 31/12/07 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 YA23 Good Practice Recommendations The manager should make sure that where property is purchased on behalf of the people who live at the home that clear records are kept of these transactions. The manager should make sure that where the individual service user does not have the capacity to give consent that an advocate is used to agree those purchases. The manager should make sure that there are clear records kept of the property that belongs to people who live at the home. The manager should be able to produce evidence of the training that staff have completed. 2. 3. 4. YA23 YA23 YA35 Rosedale Rosewood Bungalows DS0000021756.V355276.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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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