CARE HOME ADULTS 18-65
The Stables 4 The Stables Crosby Liverpool Merseyside L23 9YT Lead Inspector
Mrs Joanne Revie Key Unannounced Inspection 28th September 2007 09:00 The Stables DS0000005386.V347528.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 The Stables DS0000005386.V347528.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. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Stables Address 4 The Stables Crosby Liverpool Merseyside L23 9YT 0151 931 5787 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) H46013@mencap.org.uk Royal Mencap Society Mr Raymond Francis Hanna Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 4 LD and up to 4 PD. Two staff on duty at all times. One staff to be alone with service users only in the event that all the guidelines and risk assessments agreed by the NCSC are adhered to. Night staffing conditions of two sleep in staff to remain as previously agreed. 1st June 2006 Date of last inspection Brief Description of the Service: The Stables is registered to provide support and accommodation for four adults who have a learning disability. It is owned and run by Mencap a national organisation that provide a variety of support services to people who have a learning disability. The home is in a cul-de-sac in a quiet residential area of Crosby and fits in well with surrounding houses. It is a detached bungalow with fenced back garden and has a detached garage, which is used, as a laundry and for storage. Inside a small entrance leads to a single toilet and through to a large living/dining room. The kitchen is off the lounge and is large enough for people using wheelchairs to access. Bedrooms and the office lead off a hallway at the back of the lounge, which also provides access to one bathroom and one shower room. All of the bedrooms are single and the bathrooms are adapted for use by people who have a physical disability. There are a number of other aids fitted in the home including ceiling tracking, hoists and grab rails. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A visit to the home took place on the 28th September 2007 as part of the homes Key inspection. The organisation (MENCAP) provided information about the home in the form of a document called an” AQAA”. This gave the organisation the opportunity to tell CSCI what they felt their strengths and weaknesses were and what they were doing to develop the home further. Questionnaires were not sent out to the tenants who live at the home, as the inspector was aware that the tenants prevented them from writing. The inspector was also aware that verbal communication would be a difficulty as the express their wishes in other ways. For this reason telephone discussions were held with two different relatives who act as representatives for two of the tenants who live at the home. Three tenants were “ caestracked” this means that the site visit focused on their experience of the care and support received from the home. The site visit was unannounced and took place over six and a half hours. A variety of records relating to the care and support of the tenants, staff and maintenance of the home were viewed. Discussions were held with the manager and three members of staff. The findings of these processes are included within the evidence section of the report. Quotes from all parties spoken with are included within the summary section of the report to promote ease of reading and to illustrate key points. The weekly charge for staying at the home at the time of writing this report was £255.00 per week. This does not include newspapers chiropody, outings, holidays and clothing. Each tenant has access to their own vehicle, which is funded through motability. What the service does well:
Tenants are supported to meet all their personal care and Health care needs. This means that the tenants who live at the home receive a good standard of care and support. Staff spoken with (including the manager) showed that they were very knowledgeable about the tenants needs. This means that tenants are receiving care and support from staff who know them well. Tenants representative’s agreed that this was very important particularly due to the difficulties
The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 6 experienced by tenants regarding verbal communication. Representatives were quick to praise staff saying that “ they do an excellent job” and” (tenants name) could not live in a better place”. The home is warm and clean and presents as a homely place to live. A representative stated” It always appears very comfortable, very clean and very safe” Some areas have been identified for redecoration by the manager and plans have been developed to go ahead with this before Christmas. Staff support the tenants to lead as active a lifestyle as possible including activities in the local area and further a field. Staff have the skills and knowledge of how to keep tenants safe from abuse and have proved since the last visit that they can use these skills. This means that tenants are safe in their supervision. What has improved since the last inspection? What they could do better:
Staff are relying on passing verbal instructions amongst themselves as care records are not as up to date as they should be. This means that a mistake in a tenants care could occur if care is being delivered by a temporary (relief) staff member who does not know the tenant well. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 7 There has been some changes in the staff team due to retirement since the last visit. Positions have been filled providing the organisation receives satisfactory checks for the prospective employees. In the interim temporary staff are supporting the existing staff team. These staff tend to come to the home on a regular basis. The manager is unable to check their suitability to give support to the tenants as their personal information is held at MENCAP’s head office and not within the home (like the other permanent staff records). Ways of making this information available to the manager should be explored to reduce the risk of tenants receiving support from staff who are not qualified to do so. The manager should consider exploring and introducing protected mealtimes so that eating becomes a stress free experience for all the tenants. Records should be kept within the home of any complaints/concerns and any action taken. This is to ensure that appropriate action is being taken to address peoples concerns. The corridor leading to the bedrooms should be redecorated as part of the redecoration works. 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. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home demonstrates that it understands the need to gain as much information as possible about a new tennants needs before admission takes place. New tennants are given time and the opportunity to visit the home. EVIDENCE: A new tenant has been admitted to the home since the last visit. Records were viewed for this person, which showed that the manager had gathered a great deal of information about this person before admission took place. The information viewed included assessments from a multidisciplinary team and the manager’s own assessments. Records from the tenant’s previous placement were also available. The tenant’s representatives confirmed that the manager visited the tenant several times before admission to the home had taken place and that the tenant had visited overnight at the home. The representative also explained that he had been kept informed of all progress. The home has a statement of purpose that is available in different formats within the organisation. This was viewed and was available in the homes office. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plan documentation needs to be reviewed and in some cases implemented as not all tenants had a plan in place. Tenants are treated as individuals and supported to take every day risks. However records need to be reviewed and developed further to support this. EVIDENCE: The AQAA received from the organisation revealed that Mencap are looking at ways to improve care planning. Three essential lifestyle plans were viewed. Two had not been reviewed for over six months. The third was in the process of being developed. This plan belonged to a tenant who had been admitted to the home in April 07(five months ago). This means that staff have not got access to up to date written information about tenants needs. However discussions with three staff revealed that they were very knowledgeable about tenants needs. One explained that handover is always given and that relief staff are given a clear induction to the home. Records were not available to support this.
The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 11 Staff were observed to support tenants in a timely and appropriate manner. Although verbal communication is limited, staff were able to explain clearly the likes and dislikes of the tenants proving that they are each treated as individuals. One tenant was listening to a particular type of music and each bedroom viewed was decorated and furnished differently showing the individuals tastes and interests. Despite care plans requiring reviewing, those viewed gave a good overview of the tenants likes and dislikes. Each plan contained a selection of risk assessments to enable staff to support tenants to lead as active a life as possible. It could not be determined whether these records were valid as the plans were outdated. However the records viewed were clear and easy to follow. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality outcome in this area is good based on available evidence. Tenants are supported to take part in fulfilling activities and are involved in the local community. Tenants are supported to maintain close relationships. Daily routines are flexible although staff know tenants usual routines. Nutritious choices of meals are offered. EVIDENCE: On the day of the visit one tenant was being supported to attend a local day centre. Another two went for a walk to the local shops. The manager confirmed that three of the tenants had been abroad for week’s holidays in summer and relatives confirmed this. Both relatives spoken with believe that their relatives are supported to lead as active a lifestyle as possible. The three essential lifestyle plans viewed gave information about the activities enjoyed by each The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 13 tenant. One tenant is supported to go swimming and a regular weekly group activity of light therapy takes place also. Records viewed also showed that local activities such as pub lunches take place. One tenant is being supported to obtain a pass for a local gym. The two relatives spoken with stated that staff always make them welcome at the home whenever they visit. One tenant regularly visits home to spend time with relatives. Both relatives agreed that they are always kept informed of any changes in their relatives needs.. The home has an open visiting policy. The lunchtime meal was observed with three tenants eating a different meal from the other. Menus showed that variety of nutritious meal are offered. Staff were able to discuss the tenants food prefences in detail. One tenant was quite noisy during the meal but staff were quick to support them. Discussions with staff revealed that distractions during the meal occurring could often result in this behaviour. The introduction of protected meal times was discussed with the manager at length. One tenant was observed to be using specialised cutlery and plates to promote independence. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality outcome in this area is good based on available evidence. Tenants are supported to receive personal care as they choose. Staff ensure tenants health needs are monitored and Tenants are supported to undertake health checks. Medications are managed safely. EVIDENCE: Viewing off duties and observing staff showed that the home employs a mixed staff gender. Two care plans viewed showed that consideration had been giving to risk regarding personal care such as bathing showering etc. All three plans viewed contained records to show that close liaisons occurred between G.P.s and other health care professionals according to the tenants needs. Staff have received training regarding artificial tube feeding (peg) and written documentation was available for staff to refresh their knowledge. Basic health care checks such as optical, dental and chiropodist visits occur regularly. The two relatives spoken believed that their relatives were looked after well. The homes medication systems were viewed. Records have been developed and improved since the last visit, which means that medication amounts are
The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 15 recorded as they leave and enter the home. The manager is developing this and the storage of medications further. The home has suitable storage facilities and staff keep clear records of all medications that have been administered. Specialised equipment is available in the home for each tenant according to their needs. This was observed in the tenants’ bedrooms. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and tenants and their representatives are given information about how complain. Staff have the skills to protect the tenants from abuse and support tenants to manage their financial affairs. EVIDENCE: A discussions with the manager revealed that an ongoing Protection Of Vulnerable Adult [POVA] situation has now been resolved. The manager stated that this had been a learning curve but was able to inform the inspector of progress to date and who and how a POVA referral was to be made. The home has a clear procedure on the prevention of abuse. During discussions two staff were able to reveal the steps that they would take if they suspected that abuse had occurred. Copies of financial records were viewed. These showed that a clear audit trail is available and that tenants are supported to move monies into savings accounts if the need arises. The records showed that each tenant has their own bank account. A complaints procedure was available within the home in response to a requirement made following the last visit. Two representatives spoken with confirmed that they knew how and who to complain to. The manager explained that the records for a recent concern were being held at head office but that this procedure is being reviewed. Therefore it could not be ascertained whether
The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 17 the concern had been responded to within 28 days as detailed on the AQAA. No concerns or complaints have been raised to CSCI since the last visit. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a comfortable clean place to live. EVIDENCE: A tour of the environment was undertaken and the AQAA considered. Mencap are developing links with a housing association to ease the burden of trying to find local tradesmen to complete on going maintenance at the home. On the day of the visit no repairs were necessary although the manager stated that plans were being developed to redecorate the lounge. All areas viewed appeared to be decorated and maintained to a good standard with the exception of the corridor where bedrooms are situated. This was scuffed in places and requires re painting. The garden areas of the home were viewed and have been greatly developed since the last visit. Some areas at the back are still overgrown however all areas are now accessible due to The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 19 reflagging. Pots and baskets have been introduced at the front of the home and the side garden, which now makes a pleasant seating area. Cleaning rotas were viewed which showed that staff undertake different cleaning duties at different times during the week/month according to their shift. All areas (including bathrooms and shower rooms) appeared clean and tidy. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service employs staff who are qualified to provide care and support. The staff team is not as stable as it was but relief workers who are knowledgeable about the tennants needs are supporting this. Robust recruitment procedures are in place and staff are given good training to enable them to meet the needs of the tenants. EVIDENCE: On the day of the visit two relief staff were on duty. Discussions with one revealed that she had been employed for several months but had spent most of her time working at the stables. Discussions also revealed that induction training had been given and was ongoing. This could not be evidenced as no written information was held within the home about this member of staff. This was later discussed with the manager. The AQAA showed that there has been a staff turnover since the last site visit due to retirement. The Manager confirmed that the relief staff were familiar with residents needs and discussions with theses staff confirmed it to be true. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 21 Risk assessments are available within the home to show how many staff are needed to support each tenant with different activities.. Also Three staff files were viewed. One showed that staff had received updates this year in essential training such Health and Safety. However no other information was available as this file belonged to a relief member of staff. The remaining two files belonged to permanent staff and contained all the information required by the Care home Regulations 2001 as well as evidence of ongoing training. A discussion with the manager revealed that some staff have undertaken training in Dementia care since the last visit and that further training was being sought for the remainder. Viewing Files and the AQAA and a discussion with the manager revealed that 5 of the 8 staff who works at the home have completed an NVQ qualifications and in most cases this is level 3 NVQ. MENCAP have recognised the difficulties around sending staff on training and staffing a small home and have responded by organising in house training locally every Wednesday. The manager believes this will work well . The manager has started to complete a Learning and development Data base form which will act as a record of all staff training undertaken so that “ at a glance” training needs can be recognised. The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality outcome in this area is good, based on available evidence. The home is managed well. Relatives and Representatives are being consulted about their views of the service. The service is a safe place to live EVIDENCE: The manager has achieved a recognised management qualification since the last visit. Relatives were very positive about his ability to manage the home. He was seen to be supportive to both staff and tenants during the visit and was very knowledgeable about the individual tenants needs. MENCAP undertake annual quality assurance assessments. This has been developed further at the stables by sending surveys to representatives of the tenants so they can speak on their behalf. Both relatives confirmed that they had received questionnaires and intended to complete them. The responsible
The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 23 individual for the service undertakes quality control checks in the form of regulation26 visit, which are forwarded to CSCI on a monthly basis. A variety of certificates and records were viewed which related to fire safety and General health and safety management at the home. The home has a working fire alarm however staff are not recording that this has been tested on a weekly basis. Records were available to show that a fire evacuation practice had recently taken place The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 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 The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15;(1)(2)b Requirement Staff must have access to up to date written information regarding tenants needs and support/care required to meet these. Timescale for action 30/11/07 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 2 3 4 5 Refer to Standard YA32 Good Practice Recommendations The manager should consider keeping a record of any inductions given to relief staff to familiarise them with the service when they start work at the home. The manager should carry through his intention to source further dementia care training for staff The learning and development data form should be completed. Clear records of all complaints and concerns should be kept within the home as evidence that the home is investigating complaints appropriately. The introduction of protected meal times should be explored and impnenttaion considered so that tenants are able to eat meals in a stress free environment. YA32 YA32 YA22 YA17 The Stables DS0000005386.V347528.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Merseyside Area Office 2nd Floor, South Wing Burlington House Crosby Road North Waterloo L22 0LG 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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