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Inspection on 15/03/07 for Stowlangtoft Hall Nursing Home

Also see our care home review for Stowlangtoft Hall Nursing Home for more information

This inspection was carried out on 15th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Pre admission assessments were completed for each service user, the information was used to develop their care plans. Care plans were comprehensive, evidencing that the service users care needs were assessed, agreed with the service user and delivered by the staff in a consistent way.

What has improved since the last inspection?

Since the last inspection there is a visitors book in the foyer of the front entrance to encourage all visitors to sign in and out of the building. The control of infection policy was reviewed and the staff adhere to the practices for the safe disposal of waste.

What the care home could do better:

There were requirements made from this inspection. The medication practice must be reviewed to comply with the homes policy. When medicines are transported to the service users around the home they must be quickly and securely locked away in the event of an emergency. Training in the protection of the vulnerable adult (POVA) for staff is required to ensure that all service users are protected. The recruitment records of staff are inadequate with documents missing from one file. There was no evidence of a quality assuranceprogramme to assess feed back from service users and their relatives and staff files were not available for inspection at the home.

CARE HOMES FOR OLDER PEOPLE Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY Lead Inspector Iain Smith Unannounced Inspection 15th March 2007 09:00 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 Stowlangtoft Hall Nursing Home DS0000024506.V308919.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. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stowlangtoft Hall Nursing Home Address Stowlangtoft Bury St Edmunds Suffolk IP31 3JY 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) 01359 230216 01359 233346 iain@stowlangtofthall.co.uk Mr Hector Iain MacDonald Mrs Hilary Anne MacDonald Mrs Hilary Anne MacDonald Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability (37) of places Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: The present Stowlangtoft Hall was built in 1859 for the Maitland Wilson family and stands in seven acres of garden and woodland. In 1939 the property was let to London County Council as an evacuation centre for mothers and babies from the East End of London. The Hall has been used as a nursing home since 1969. Many of the original features of the hall have been retained for the enjoyment of the service users and visitors, including an Orangery with a glazed dome roof where service users may sit in the warmer weather. The home has established strong links with the local community and the larger grounds around the home are often used for community events. The home is currently registered for 37 service users who are elderly frail and are admitted for either short or long term care. The home actively encourages prospective service users and their relatives to visit and talk to management and service users about the services provided and to attend for trial visits. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced key inspection for the year 2006/2007 of Stowlangtoft Hall Nursing Home. This visit was made by Iain Smith Lead Inspector. The inspection commenced at 9.15 and was completed at 16.00 hrs having followed the care homes inspection methodology that included interviewing staff, service users, examining care plans, policies, procedures and a tour of the environment. The manager Mark Roscoe who is the deputy to the registered manager and nurse manager Maureen Tilbrook were present throughout the day and contributed fully to the inspection process. The registered manager Hilary MacDonald was not available on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: There were requirements made from this inspection. The medication practice must be reviewed to comply with the homes policy. When medicines are transported to the service users around the home they must be quickly and securely locked away in the event of an emergency. Training in the protection of the vulnerable adult (POVA) for staff is required to ensure that all service users are protected. The recruitment records of staff are inadequate with documents missing from one file. There was no evidence of a quality assurance Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 6 programme to assess feed back from service users and their relatives and staff files were not available for inspection at the home. 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. Stowlangtoft Hall Nursing Home DS0000024506.V308919.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 Stowlangtoft Hall Nursing Home DS0000024506.V308919.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): Standards 3 and 6 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be assured that their care needs are assessed prior to them entering the home and that all their needs can be met by appropriately trained and skilled care staff. Those service users who are admitted for intermediate care can be assured their care needs will be met. EVIDENCE: The care needs of each resident are assessed prior to their admission and the three care plans that were examined each evidenced that an assessment was completed. The care plans included the assessments for example mobility, medication and nutrition. There is a standard form that the appropriate person, who is undertaking the assessment, takes with them. The home has the registered manager, manager and nurse manager, each of them are trained nurses and trained to do the assessments, each of whom are able to visit each prospective service user and complete an assessment prior to admission. The Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 9 information included an assessment of their daily living, communication, eating and drinking and mobilising. The assessment is completed to ensure that the home is able to meet the needs of each individual. The assessment form the home has identifies the reasons for an admission and if the prospective service user meets the criteria or not. Intermediate care is provided in the home for service users who will be admitted from hospital and discharged back to their home. Staff were seen to be qualified and trained to ensure the service users received appropriate promotion of mobility and continence. Some staff are trained nurses and there was evidence of continence programmes in the home. Stowlangtoft Hall Nursing Home DS0000024506.V308919.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident can expect their care needs to be assessed prior to admission and a care plan formulated to ensure their needs are identified and met. The homes medication policies protect them however they are not protected by the homes procedures for dealing with medicines. The residents can feel that they are treated with respect and their right to privacy is upheld. EVIDENCE: The three care plans that were examined were generated from the pre admission assessment. The plans set out the care needs for each service user. One service user was nursed in bed therefore the care plan identified their needs relating to pressure area care, fluid balance and nutrition. Another care plan identified the service user had communication problems and the plan clearly stated the approach the staff would take to ensure the service user was cared for appropriately. An example was to give time to the service user and explain what was required of them. The plan was specific for staff to be respectful of the person’s dignity and to approach them in a calm way. There was evidence that the care plans were reviewed monthly. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 11 There was evidence that the service users health care needs were assessed and recorded. Examples of this were, nutritional assessments, pressure sore assessments, promotion of continence and that each service user was registered with a General Practitioner. The nurse manager and trained staff were responsible for the compilation of the care plans and reviews. The medication policy was examined and found to be appropriate. The policy stated clearly the responsibilities of staff including ensuring that the care plan reflected the medication that each service user was prescribed. The policy also made reference to the responsibilities the trained nurse had to the Nursing and Midwifery Council (NMC). The medication round was observed and the nurse responsible for the medication was observed to administer three or four medicines into pots, with the names of the service user and placed on a small tray and then proceed to take the medication to each of the service users in the home. The medicine trolley was located in the medicine cupboard and secured to the wall. The trolley was not removed from the cupboard to ensure the safety of the medicines whilst administering medication around the home. The Medication Administration Records (MAR) accompanied the nurse, who was seen to sign the chart following the administration of medication to each service user. This procedure continued until all the drugs were administered. The controlled drugs book was examined and found to be correctly signed by two members of staff both registered nurses. The privacy and dignity of the service users was assessed throughout the inspection day. The staff were observed to respect each service user by speaking to them in a polite and respectful way. Staff were giving the service users choice with what they wished to eat and drink. The service users were wearing their own clothes. When service users were using the toilet or bathroom the doors were observed to be closed and staff were seen to knock on bedroom doors before entering. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 12 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): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect the home to offer a wide range of activities and to encourage each person to maintain social contacts. Service users are helped to exercise choice and control over their lives and are offered a choice of meals in pleasant surroundings at convenient times. EVIDENCE: The routines of daily living and activities were made varied for the service users. There were opportunities for service users to participate in activities and choose if they wished to stay in their rooms and have a newspaper and magazines to read or be assisted to the large dining room to eat and socialise. The home has recently employed an activities person, who has nursing care experience. They arranged a wide range of activities for example, taking service users out shopping and painting in the art room in the home. There was evidence of service users watching a video in the afternoon of the inspection and then being encouraged to share their experiences relating to that. The programme of activities was displayed and a copy was distributed to each of the service users rooms. The home has made available a separate room for activities that is located close to the dining area. There are tables in the room for service users to paint pictures and participate in art activities. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 13 One service user stated that ‘I can pick and choose what I want to do depending on how I feel’. Three visitors were seen in the home and two of the visitors were accompanied by a dog. The member of staff stated that the service user who was visited, responded to the company of the dog and looked forward to seeing it. The lunchtime was observed. The food was prepared in the kitchen and served on plates before taking the meals to each of the service users. The service users had the choice of where they wished to eat their meals for example; they could stay in their room or be assisted to sit in the large dining room. Sherry and wine were available for all service users and one service user stated’ I look forward to this (wine) with my meal’. The tables were set with a tablecloth, place mats, cutlery and condiments. The meals for the eight service users who were sitting in the dining room were brought from the kitchen in a heated trolley. There was a menu available and service users were asked on the morning what their choice was for the lunchtime. One service user stated ‘If I don’t like what is on the menu I can choose something else’. One service user stated ‘ good lunch’. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect their concerns and complaints to be listened to and acted upon. The manager ensures safeguarding policies are in place however the staff are not formally trained in POVA procedures. EVIDENCE: The complaints procedure for the home is displayed in the entrance of the home and included a part of the statement of purpose. There were no complaints received since the last inspection. The home ensures that the Protection of Vulnerable Adults (POVA) policy is available for staff to read and refer to. Staff are instructed in POVA policies during their induction and one member of staff stated ‘I know what to do if there is an allegation of abuse’. There was no evidence in the staff files that were examined, that staff had attended any POVA training. However, since the inspection the registered manager has stated that POVA training is included in the Common Induction Standards that staff complete on commencement of the employment. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 15 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): Standards 19 and 26 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a safe and well maintained home that is clean and pleasant. EVIDENCE: The home where service users live is well maintained and clean. All bedrooms are carpeted. There is some wooden flooring for example, in the main entrance hall of the home. One room, which is located off the main entrance, is currently not used by the service users. There is a dining area with a lounge beside this room, where service users access. On the afternoon of the inspection there were service users sitting enjoying a watching a video. Each of the bedrooms is clean and tidy with furniture and furnishings that are domestic in character and of good quality. There is a lift to the upper floors therefore service users and staff are able to access all parts of the home if required. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 16 Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 17 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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can expect the home to provide appropriate numbers and skill mix of staff to meet their needs. However, the service users cannot be consistently assured that they can be fully protected by staff receiving POVA training or recruitment checking. EVIDENCE: Staff numbers and the skill mix of staff were appropriate for the care of the service users. There was a registered nurse on duty to cover the 24 hour period. In support there was a nurse manager who worked five days a week and the manager is a registered nurse. The designated person in charge was responsible for allocating the tasks for the day, handover of the shift and to ensure that care plans were updated. On the morning of the inspection there were two registered nurses with five carers and the rota stated that there were four carers and one trained staff in the afternoon. There were housekeeping and kitchen staff in support of the care staff to ensure the service users needs were met. Of the 20 carers five had achieved their NVQ level two qualification. The nurse manager stated that they were qualified to assess the carers. The recruitment records of three staff who were selected for inspection were not available in the home. The manager stated that no staff records or training records were available as the registered provider had them in their possession. It was confirmed when the registered person contacted the home that all records were in his possession. It was agreed the records be brought into the Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 18 CSCI office and the inspector assessed three staff files. The files included two references, contract of employment, training certificates for example manual handling. In one of the three files there was no evidence of a POVA first or CRB enhanced check. The registered person was requested to provide evidence of this however was not forthcoming. Staff training records evidenced that manual handling; continence care and nutritional training were completed. The nurse manager stated that the end of life training had been arranged for staff this included the Liverpool Care Pathway and the Gold Standard Framework. The community dietician had visited the home and this was evidenced in one care plan. There was no evidence that staff had received the protection of vulnerable adult (POVA) training. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,37 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can expect the home to be managed by a person who is fit to be in charge. The health, safety and welfare of the service users are promoted and protected however not all records are available. EVIDENCE: The registered manager was not available in the home on the day of inspection however the manager and nurse manager were present. The manager stated that he is a registered nurse and is being mentored and will be nominated for the registered managers position in the future. The manager demonstrated that he had attended a number of training sessions including manual handling. The manager was unable to demonstrate that the home has a quality assurance programme and quality monitoring system. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 20 The manager stated that he had the responsibility for the petty cash and there were records to evidence this. The service users relatives managed all service users finances. The provider stated after the inspection, that they were responsible for the invoices and accounts and maintained a spreadsheet to ensure there was a record for all service users. Individual personal records for staff and financial records were not readily available in the home for inspection. Safe working practices were evidenced in the home. The staff had attended food hygiene, manual handling and fire training. There was safe storage of substances hazardous to health with an appropriate secure cupboard. Health and safety policies and procedures were available for staff to refer to and all accidents and incidents were recorded. Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 x 3 X 2 3 Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 22 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. 1. Standard OP9 Regulation 13.2 Timescale for action When medicines are transported 30/06/07 to the service users around the home, it must be done so in a secure manner. Medicines transported around the home must be quickly and securely locked away in the event of an emergency. The registered person shall make 29/07/07 arrangements, by training staff to prevent service users being harmed or being placed at risk of harm. The registered person must 30/05/07 ensure that all relevant information and documentation is obtained prior to the employment of a member of staff. The registered person shall 30/04/08 establish and maintain a system for reviewing at appropriate intervals the quality of care provided in the home. A record of all staff files must be 30/04/07 kept in the home and made available for inspection. Requirement 2. OP18 OP30 13.6 3. OP29 7,9,19 Schedule 2 4. OP33 24 5 OP37 17 Schedule 4 Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 23 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 OP35 Good Practice Recommendations The registered manager procedures for the home. should review the financial Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 © 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 Stowlangtoft Hall Nursing Home DS0000024506.V308919.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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