CARE HOMES FOR OLDER PEOPLE
Stones Place Skellingthorpe Road Lincoln Lincs LN6 0PA Lead Inspector
Mr Doug Tunmore Key Unannounced Inspection 31st January 2007 09:30 X10015.doc Version 1.40 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 Stones Place DS0000002426.V328917.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Stones Place Address Skellingthorpe Road Lincoln Lincs LN6 0PA 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) 01522 684325 home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Carole Ann Kus Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories: Old Age, not falling within any other category (OP) (42) The maximum number of service users to be accommodated is 42. Date of last inspection 19th June 2006 Brief Description of the Service: Stones Place is situated to the southwest of the City of Lincoln close to a main road where a regular bus service is available. This home is a two storey, purpose built care home offering accommodation in 42 single bedrooms some of which can be converted to double rooms if required. A recent extension has been completed which includes 6 new bedrooms with the total of 42 and a first floor communal area plus an extension to the dining room. The home has well maintained gardens to the front and rear of the property, with a large car park at the front of the building. There are community facilities in the vicinity. The home is registered to provide personal care for up to 42 residents. Nursing care is not provided. The aims and objectives outlined in the Service Users Guide states that the home aims to offer a safe, secure, homely environment and to enhance the quality of life for the residents. There is a Christian ethos to the home but there are people of varying denominations cared for within the home. The home is owned by The Methodist Homes for the Aged. The current scale of charges at this home starts at £379.00 to £476.00 per week. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took into account any previous information held by CSCI including the homes previous inspection reports, their service history and the homes pre-inspection questionnaire sent to the home by the Commission prior to this inspection. The site inspection consisted of case tracking a sample of two residents records and assessing their care. The regulator spoke with one resident who was being case tracked. During the inspection undertaken in June 06 the inspector spent time with two visitors, one being a community nurse and a regular visitor to the home, a member of the care staff, the cook, the assistant home manager and the registered manager. The homes service manager was present during the whole of this inspection. The comments from these people will be incorporated into this inspection report, as will residents questionnaires, of which thirty-seven were received. This inspection has been carried out to examine the administration of medication in which an immediate requirement was made in June 06. All other minimum standards in which a requirement or recommendation was not made will only have a cursory inspection to ensure that these standards have been maintained. A partial tour of the home and a review of a sample of the records were also included. What the service does well: What has improved since the last inspection?
The home has taken action to address those requirements made in the last inspection of this home. Files seen showed that care staff undertake supervision either by the manager or a senior carer, which is formalised, addressing all those aspects required for the supervision and recording of this
Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 6 process. National Vocational training has now been made available for staff to ensure that adequate numbers of trained care workers are available in the home. The home carries out risk assessments on those residents who use walking aids and have had falls. 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. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are admitted into the home only after a full needs assessment has been carried out either by the home and, or health care or social care agencies. Written confirmation that the home can meet a prospective residents needs is also undertaken prior to admission. This home does not provide intermediate care. EVIDENCE: A review of all information available prior to this inspection and evidence seen at the inspection dated June 06 showed that the home does not admit residents without a care needs assessment being undertaken. Prospective residents are also written to by the home confirming that they can meet the prospective residents care needs or not. One resident at that inspection stated
Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 9 that she had a short stay prior to admission when an assessment was undertaken. Another confirmed that a senior carer had visited her at home prior to admission. Contracts were seen on residents files and the Commission is in receipt of evidence which shows that twenty four residents had received a contract and ten stated that they had not. Those residents who were being case tracked at this inspection were found to have a contract outlining their care provision and its cost on file. The homes pre-admission care needs assessment form was seen and found to explore all aspects of residents care needs including physical, social, health and personal care needs. There was also evidence that their previous lifestyles, wishes and aspirations had been discussed and recorded. The manager stated that the care needs assessment is a new document, which has been introduced recently to ensure that residents are properly assessed. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents or their representatives are involved in the care plans. The home administers medication appropriately to residents. There is good care planning in this home, which helps ensure that the general health and welfare of residents is addressed. EVIDENCE: A review of all information available prior to this inspection and a previous key inspection carried out in June 06 at this home has evidenced that either residents or their representatives are involved in the care plans. All residents have detailed care plans, which describe their health and welfare needs. Care plans outlined risk assessments, nutritional and dependency assessments. Care plans also evidenced that they have been reviewed on a monthly basis or sooner depending on changing needs. The reviews and care plans of residents had been signed and dated by the carer and the resident. Residents and
Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 11 visitors seen during the 06 inspection, commented that they have been involved in their care plans and reviews. Individual care plans evidenced that accidents are recorded in the homes accident book and in the residents daily notes. The home also uses body maps for the mapping of any cuts or abrasions to residents. Risk assessments were available for those residents who use walking aids, which describe the requirements that would offer less risk from falls. One resident confirmed during the 06 inspection that her three wheeled Zimmer frame had been converted by the home to meet her special needs. This inspection found that the homes notifiable incidents record corresponded with the Commissions service history of the home relating to accidents to residents. Files seen during the June 06 inspection confirmed that health care professionals visit the home when required by the residents. A carer at that time demonstrated that she was aware of maintaining the privacy and dignity of residents and treating them with respect. A resident stated during this inspection that ‘when I use the call button, staff come quickly’. She also commented that I have no experience of not being supported and I am very happy with the atmosphere here’. A carer commented that the morale has improved in the home since last year and there is adequate staffing at the present time. Questionnaires received back from the home showed that eleven residents felt that they receive the support that they need and twenty-three felt that they usually received the support they need and three residents said they sometimes receive the support they need. A visiting community nurse confirmed that she visits the home weekly and has good communication with this establishment and she also said that ‘this home is a really nice and peaceful home’. The pharmacist inspected the home on the 29/04/05 and recorded that ‘minor action points had been made, which have been addressed by the home’. Residents medication sheets were seen and it was found that appropriate records are kept. Blister packs containing residents medication were checked and found to correspond with medication given and recorded. There is a controlled drugs cupboard and medication book, which has the two required signatures for medication given. There are medication forms detailing medication received and medication returned to the pharmacist. The provider also undertakes spot checks on medication procedures, with the last one being undertaken on the 1101/07, with no discrepancies found. The last three monthly check was undertaken on the 21/11/06, with no discrepancies found. The manager stated that only senior staff and night carers undertake the administration of medication. The senior carer undertaking medication on the
Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 12 day of the inspection was aware of medical alerts and evidenced that procedures were in place for residents who are diabetics and inject insulin. Medication training for designated carers was undertaken in August and September 06. The file of a resident who self medicates was seen and evidenced that she had a risk assessment, which was dated and signed by that resident. Residents questionnaires showed that nine felt that staff listen and act on what they say, twenty one felt that staff usually listen and act on what they say and six felt that sometimes staff listen and act on what they say. The same questionnaire showed that eight felt that staff were available when needed, twenty three felt that usually staff were available and five said sometimes, with one resident stating never. A resident commented that she has seen the GP recently due to a chesty cough. She also said that she can wash herself but needs carers to bath her and that ‘They are so very kind, I can’t find any fault with them’. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities are made available to residents. Relatives and friends of residents are made welcome in this home. Meals are well managed with choices available to residents. EVIDENCE: A previous inspection carried out in June 06 found that the visitors book had signatures of friends and family who visited throughout the day. A community nurse commented during the inspection that ‘staff are very welcoming and cooperative and there is always someone to speak to about the care of residents’. Residents also confirmed that they have visitors in their rooms and that they are made welcome by care staff. A resident commented during this inspection that she sees her family in the privacy of her room.
Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 14 Resident’s files seen in June 06 showed that residents ‘application forms’ completed by themselves or their representatives identify their perceived needs relating to mobility, religious beliefs, activities and social life. The home also undertakes pre-admission care needs assessments, which also identifies ‘hobbies and pastimes’, as well as levels of expected participation. Tick boxes are available, on the care needs admission form, which identifies general events but does not evidence any particular activity or hobby, which the residents may wish to undertake in the space provided for comments. Residents likes or dislikes relating to their everyday living are also not identified in this document. A contract monitoring visit by Lincolnshire County Council dated 31/05/06 found that ‘the home employs an activities co-ordinator for 25 hrs per week. Monday to Friday and a range of one to one and group activities takes place, which also include local trips in small groups.’ Information sent to the Commission in June 06 by the home showed that a weekly activities diary is available on the homes notice board for the information of residents. A list of residents who undertake activities such as bowls, bingo, art class or quizzes is kept for the homes quality assurance report. This inspection identified a more wide ranging list of activities on the notice board. The activities co-ordinator confirmed that the provider has recruited volunteers (8) who attend the home to help out with activities, run the trolley shop and take residents for appointments. The co-ordinator also stated that residents now attend an over fifty fives club, Wednesday is bowling and a social club is attended on Fridays, which includes going on outings. The contract monitoring visit also identified that there are daily prayer meetings and the home has a Christian ethos. A resident confirmed that the food is very good and that a choice is available. The service manager said that all residents could have their breakfast in bed if they so wish every morning of the week. Residents questionnaires evidenced that nine always liked the meals and eighteen usually did, with eight residents stating they sometimes liked the meals. On a previous inspection residents confirmed that everybody can have a choice of meals and that breakfast is served in their bedrooms. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes the issue of addressing complaints very seriously and has a comprehensive complaints policy. Staff are aware of how to respond to a complaint or an adult protection allegation. EVIDENCE: The provider displays the service users guide, which contains the homes complaint procedures, in the main entrance. The home has a detailed complaints procedure. The homes complaints log was seen, which contained one complaint, which was logged appropriately as per the homes policies and procedures. The service manager confirmed that all such issues are brought to her attention and form part of the homes quality assurance audit. One resident commented during the June 06 inspection that ‘the manager was approachable’ and she would see her if he had a complaint’. Another resident who was being case tracked and had made a complaint confirmed that the manager had seen her and written to her about her complaint. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 16 The questionnaires returned to the Commission showed that fourteen residents knew how to make a complaint and thirteen usually did, four sometimes knew. Previous inspection have found that care workers are aware of the homes safeguarding vulnerable adults policy and could speak knowledgeably about abusive practices and what action they would take if this came to their attention. All staff received safeguarding vulnerable adults training in October 06. A resident confirmed that she ‘felt safe enough in this home’. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, the standard of the environment and its facilities are appropriate and safe for the needs of residents. The home is clean and tidy with a pleasant smell throughout the home. EVIDENCE: Previous inspections have found that home has a rolling maintenance programme, which shows forthcoming maintenance and decoration to be carried out externally and internally at the home. The manager said that since the last inspection three bedrooms have been decorated including new soft furnishings, as has the reception area to the home. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 18 The contract monitoring visit found that ‘on a tour of the premises it was noted to be clean, bright home furnished and maintained to a high standard’. The homes risk assessments were seen which included generic assessments for the home and those individual risks identified for residents. The service manager commented that all windows have been fitted with window restrictors, which cannot be overridden. However, she felt that in the summer residents might well wish to have their windows open and risk assessments will be completed for these residents. The home employs four cleaners, a laundry worker and a maintenance man who carries out the cleaning of carpets and decoration of the home. All cleaners have undertaken basic hygiene courses and fire training. Previous inspection found that both visitors and residents expressed the view that the home is well maintained and clean. A residents stated at this inspection that ‘I have all my own things here, it makes a difference’. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Appropriate recruitment practices are in place. Staffing levels currently meets the needs of residents. The home provides adequate training for care staff. Staff were seen to be competent in carrying out their care tasks. EVIDENCE: A review of all the information made available at the June 06 inspection, including two files relating to the homes recruitment process were seen. It was found at that time that; all interview records are kept of prospective appointee care workers which are to be found on their personnel file. Current photographs or identification are available in care workers files, as well as Criminal record Bureau checks (CRB). A carer stated that she has had CRB checks prior to commencing work at this home. Care workers have been given The General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. The homes training profile evidenced that eighteen carers out of a complement of thirty carers have NVQ (National Vocational Qualifications) level 2. The
Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 20 home has 60 of its care staff trained with the recommended level being 50 . The homes rota showed that from 06:45 am to 14:15 hrs there is one senior carer and four care assistants, the same number of staff are on duty from 14:00 hrs to21: 30 hrs. Night duty is shared between three carers, with a senior carer/manager on standby. The services manager stated that staffing numbers meets the Residential Forums staffing guide. One carer stated that there are enough care staff on duty at the present time, even in the busiest of times. She also confirmed that she had undertaken medication training, infection control, moving and handling, management, supervision and appraisals. Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is suitably qualified and experienced to carryout her tasks. Records seen show that residents health and general welfare and safety are promoted. The home ensures that that the residents have the opportunity to voice their views and opinions. Accurate records are kept of residents monies. EVIDENCE: The registered manager has completed a Diploma in Health & Social Welfare and also has a Certificate in Management Studies. She has twenty-two years experience in working with both people with learning disabilities and the elderly in residential and day care settings. The contract monitoring visit
Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 22 undertaken found that on the day of their inspection ‘ it was observed that there is a good rapport between the manager, staff, residents and visitors’. The home conducts an in-house quality assurance report and an independent survey carried out by Methodist Homes. Questionnaires have gone out to residents and relatives, which are sent directly to those conducting the survey. The survey was seen by the inspector, which covers many aspects relating to the running of the home and the conduct of care workers. An internal audit was undertaken on the November 06. The manager stated that all audits/surveys are posted on the notice board for the information of residents and relatives and discussed at residents meetings. The contracting monitoring visit found that the home has ‘excellent quality monitoring systems’. The minutes of the last residents meeting held in November 06 showed that residents are encouraged to voice their views and are actively involved in issues relating to the running of the home. The provider only deals with personal allowances of residents, which are kept at the home. All other monies relating to funding are paid into the homes bank account on a standing order by relatives. The contract monitoring visit dated 25/04/06 sampled service users financial records and found them to be accurate and records well maintained’. Due to this no inspection of resident’s monies was undertaken. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. The homes pre-inspection questioner evidenced that fire alarm, fire drills and emergency lighting checks have been undertaken. Care staff also receive fire training as part of the homes initial training and as a regular training event. The contract monitoring report stated that ‘Health & Safety systems are very robust’. Stones Place DS0000002426.V328917.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 Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 X x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stones Place DS0000002426.V328917.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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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