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Inspection on 07/12/05 for Witnesham Nursing Home

Also see our care home review for Witnesham Nursing Home for more information

This inspection was carried out on 7th December 2005.

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

There is a full programme of activities with something planned for every day. These are sometimes managed by the staff and sometimes external people come to the home to offer entertainment or bring goods for sale such as clothes or toiletries. The home maintains close links with a local group called `Friends of Witnesham` who raise money for non-medical items for the home, such as a video recorder, but also assist in the activities programme. There was evidence of a wide and varied training programme for the staff making use of specialist nurses to train in their field. The staff files seen were comprehensive with all the required checks evident and all kept in good order. The records of wound care and the care plans for wounds were very full with good evaluation of the progress of the wounds and appropriate use of photographs.

What has improved since the last inspection?

The menus have been reviewed and now offer a wider choice to residents, including a vegetarian option at every meal. Planning to extend the home and reduce the number of double rooms is being progressed with planning permission agreed.

What the care home could do better:

The Protection of Vulnerable Adults (POVA) policy needs to be updated in line with the most recent guidelines for the county and POVA training given to ancillary staff. To provide an audit trail receipts must be kept with the records of residents` finances and not given to relatives. Two small changes need to be incorporated in the medication administration practice to further protect staff and residents. An explanation must be recorded if the code `F-other` is used on the medication administration record (MAR sheets) and `as required` (PRN) medication that gives a choice of dose must have the dose given recorded. Care plans and daily records could give more detail of the residents` psychological needs and their moods rather than just their physical well-being.

CARE HOMES FOR OLDER PEOPLE Witnesham Nursing Home Wearholme, The Street Witnesham Ipswich Suffolk IP6 9HG Lead Inspector Jane Offord Unannounced Inspection 7th December 2005 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 Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 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. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Witnesham Nursing Home Address Wearholme, The Street Witnesham Ipswich Suffolk IP6 9HG 01473 785828 01473 785779 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) Dibcan Limited Mrs Carole Ann Glegg Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: Witnesham Nursing home is situated in the village of Witnesham on the northern outskirts of Ipswich. The home is registered as a care home with nursing for a maximum of 30 service users in the category of older people. The home has 2 lounges, a dining room with a small private sitting area adjoining and all bedrooms are adequately furnished and decorated with each service user being able to choose the colour scheme of their own room. Service users are encouraged to bring in personal possessions and small items of furniture for the rooms. Most of the rooms are of single occupancy. There is a nurse call system in place that is accessible to service users in all bedrooms, bathrooms and communal areas. A shaft lift allows access to the first floor and the home and its gardens are accessible to wheelchair users. The manager leads a dedicated team of care staff who are trained to meet the needs of the service user. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9:30 and 15:15 on a weekday. Matron was helping in the kitchen, as the chef was on annual leave, but became available to assist during the day. The personal files and care plans of three residents were seen, three staff files, the policy folder, the complaints log, the accident/incident records, staff training records and the menu book were all seen in the course of the day. Part of a medication administration round was followed; a tour of the house and a visit to the kitchens was made. The staffing rota was seen as were some maintenance records and matron explained the system for managing residents’ personal money. The inspector spoke to a number of residents and several staff. The home was clean and tidy and residents looked comfortable. Staff and resident interaction was relaxed and appropriate. What the service does well: What has improved since the last inspection? Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 6 The menus have been reviewed and now offer a wider choice to residents, including a vegetarian option at every meal. Planning to extend the home and reduce the number of double rooms is being progressed with planning permission agreed. 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. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 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 Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 People who use this service can expect to have their needs assessed and be assured they will be met prior to admission to the home. EVIDENCE: There was evidence in the residents’ files that were seen that a pre-admission assessment is undertaken. Areas that were covered included past medical history, present medication, allergies, social history and previous occupation. The physical assessment was completed under headings of mental state, communication, mobility, continence, diet, skin integrity and wound dressings. On the day of inspection a review was being done for a resident on respite care. A discussion between matron and the social worker indicated that matron was to assess two people at the hospital the following day before they would know if the respite bed could be extended for a further week. The policy folder contained a policy on a trial period of residency allowing prospective residents to ‘test drive’ the service. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service can expect to have a plan of care identifying their needs and that their health needs will be met. They can expect to be treated with dignity but they cannot be assured that the present medication policy will always protect them or that the care plan will address their psychological needs. EVIDENCE: Care plans seen were well compiled for physical needs. They covered areas such as mobility, personal hygiene, pressure area care, wound care, elimination, safe environment, communication, nutrition, sleep, medication and choice. The plan for pressure area care included details of any specialist equipment needed i.e. repose mattress. The plan for sleep included the resident’s preferred getting up and going to bed time together with preferences for sleeping with a light on or off and the door open or shut. There was documented evidence that health checks were being done regularly. One file had a record of the resident’s blood pressure, another recorded weight. One resident with a leg ulcer had had a wound swab taken to eliminate the possibility of an MRSA infection. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 10 Matron said that the residents were able to keep their own GP if they were registered with a local practice but the majority of the residents had had to change their GP when they were admitted to the home. The GP visited every Friday and was available by phone or to make extra visits if needed. The files had records of visits by the GP and other health professionals such as the tissue viability nurse. Wound care plans were detailed with descriptions of the wound and measurements. In some cases photographs were used to give an ongoing comparison and evaluate whether the wound was healing or not. The written evaluation each time a dressing was renewed gave clear details of the progress of the wound. The daily records were all in appropriate language and recorded the physical care given. Neither the daily records nor the care plans seen mentioned any mood or psychological need of the resident. Matron said that there were residents who had some interventions recorded for these needs but agreed that more could be done to address holistic care of the residents. Staff were observed knocking on doors before entering rooms and speaking respectfully to residents. Residents were assisted sensitively with their meals if they were unable to manage alone. Residents wishes were sought and respected so when a carer offered to open a Christmas card for a resident and the resident said they did not want it opened, it was replaced on their table unopened. Part of a medication round was observed. Medication was given carefully at a speed the resident could cope with and in a format acceptable to them. The trolley was locked if being left or taken with the nurse when they moved to another room. The MAR sheets were seen and each one had the resident’s photograph for identification. No gaps were seen in the signature boxes. On one MAR sheet the code ‘F- other’ was being used when a resident did not have analgesia as they had no pain at the time. There was no recorded explanation of why the medication had not been administered. When ‘as required’ (PRN) medication gives a choice of dose i.e. one tablet or two, the dose given was not recorded so there was no audit trail to check stock levels. The medication administration policy was seen and contained a procedure for managing ‘homely’ remedies that had been agreed with the GP. It did not contain guidance on the covert administration of medication. The Controlled Drugs (CDs) register was seen and was correctly completed. A random check was made on two of the CDs in the cupboard and they tallied with the records. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use this service can expect to have a variety of activities offered to them, be encouraged to maintain contact with their family and friends and choose how they spend their time. They can also expect to be offered a balanced and wholesome diet. EVIDENCE: In the entrance hall there was a list of the activities planned for the week and a list of the events planned for the month. The staff manage an activity each afternoon like board games or bingo. Some afternoons there is an external entertainer singing or story telling. The week before the inspection the home had held a Christmas Fayre helped by the group called ‘Friends of Witnesham’, so the Christmas tree and decorations were up in the lounge. Some of the paper chains had been made and decorated by the residents. St. Andrew’s Day had recently been celebrated with flags and Scottish music. There were plans for a clothes show and some carol singing before Christmas. Matron said that the Friends of Witnesham always bought presents for residents at Christmas and Easter and would be consulting with the staff to make suitable choices for individuals. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 12 During the day residents were observed pursuing a variety of pastimes in their rooms or in the main lounge. Some were reading, some listening to the radio. One resident was filling in a colouring book, another reading a newspaper. There were visitors coming and going during the day and they were welcomed by the staff. In the residents’ files note had been made of their religion, if any, and whether they wished to have contact with a priest or representative of the church. Matron said that the home had regular visits from a priest of the Church of England and a Roman Catholic father. Holy Communion is brought to the home each month and there was a planned Communion service for the following week just prior to Christmas. The menus book was seen and showed a wide variety of meals. There was a vegetarian choice each lunch and supper as well as the main meat or fish meal. The chef spoken with confirmed that in addition to the menu of the day there were always jacket potatoes, omelettes and salads available. At afternoon tea there were home baked cakes and there was always fresh fruit. The menu on the day of inspection offered sausages in gravy or cheese and potato pie with fresh vegetables. The chef was preparing a cheesecake for supper. The food stores were inspected and contained a good supply of fresh vegetables and a large stock of dry ingredients. The refrigerators and freezers were all running at temperatures that were safe for food storage. Food in the refrigerator was covered and date labelled. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 People who use this service can expect that complaints will be taken seriously and that their legal rights will be protected however they cannot be assured that the present POVA policy will protect them from abuse. EVIDENCE: There is a robust complaints policy, which was on display in the entrance hall. Since the last inspection the Commission for Social Care Inspection (CSCI) has received one complaint with three elements relating to this service and this has been investigated. Two elements of the complaint were unresolved but the third, which related the collection of medication from the pharmacy by people not employed by the service, has resulted in a change to policy. The complaints log was seen and the home has not received a complaint recently. One resident was asked if they knew who to complain to if they needed to raise a concern. They said, ‘I don’t need to complain, everyone is lovely’. Matron said that every resident was registered on the Electoral Roll when they were admitted to the home. They also ensure that the applications for postal votes are completed for residents unable to get to a polling station. Prepared applications were seen on the day of inspection. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 14 Staff spoken to were very clear about their duty to report any suspicion they had of potentially abusive situations. The care staff have all received POVA training and the training records seen evidenced this. Ancillary staff have not received formal POVA training but were also clear about their duty. The POVA policy seen needs to be updated to reflect the most recent guidelines issued for the county. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 26 People who use this service can expect to live in a comfortable well-maintained home with specialist equipment available to help maximise their independence if needed and with policies in place to protect them from infection. EVIDENCE: The building is old and rambling but was clean and tidy with no unpleasant odours on the day of inspection. The communal rooms were large with a lot of natural light and views over the garden. There is a patio area that can be accessed from the lounge and catches a lot of sunshine. Wheelchair access to the patio and garden is from any outside door as they all have ramps. Records of day-to-day maintenance were seen and show that the maintenance person has a rolling programme of work as well as undertaking emergency repairs. Empty rooms are redecorated but there is also a programme for the communal parts of the home to be redecorated routinely. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 16 Residents’ rooms were all individualised. Some residents had furnished their rooms with their own furniture and soft furnishings; others had brought photographs and pictures. There was evidence of special interests with one room containing a lot of pictures of a particular pop star and others with plants and flowers. There were a number of double occupancy rooms all of which had screens available for privacy during personal care. A few rooms had en suite shower and toilet but all had wash hand basins. There was evidence throughout the building of specialised equipment to aid independence. There were a number of hoists and other moving and handling equipment. There was a shaft lift between the ground and first floor and a chair lift on the first floor to manage a three stair change in level. There were wheelchairs, raised toilet seats, grab rails and walking frames in use. A number of beds had bed rails and protectors and some rooms had pressure mats in place. There was evidence in the home of liquid soap and paper towels at all the washbasins. Disposable gloves and aprons were also available. The home has a contract with a laundry to do all the linen but the residents’ personal clothing is washed on site. The laundry was not inspected on this occasion. There was evidence in the training files seen that staff have training in infection control often delivered by the specialist infection control nurse. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 People who use this service can expect to be cared for by staff who have been properly recruited, trained to meet their needs and are rostered in sufficient numbers to deliver the care needed. EVIDENCE: The rotas were seen and showed that an early shift is covered by one registered nurse with five carers, a late shift is covered by one registered nurse and four carers and a night shift has one registered nurse and three carers. Matron, who is a registered nurse, works five days a week but is not counted in the numbers. Staff spoken with felt that generally the numbers were sufficient for the dependency of the residents. Some parts of the day were a little more difficult to manage than others, for example after supper there was a lot of demand for people to go to bed, in a short space of time, and staff breaks had to be managed as well. Matron had recently rostered extra staff for a period to cover a temporary health need among the residents. The staff files seen all contained all the checks and identity documents required by the National Minimum Standards. In addition the files were all in good order and accessed easily. The training records seen show a commitment to a wide training programme. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36, 38 People who use this service can expect that their views will be sought and that their health and safety will be protected but they cannot be assured that the present procedure for managing their personal money will allow an audit trail. EVIDENCE: The notes of residents’ meetings were seen and showed that issues that were raised were actioned. This was evident from comments recorded at the subsequent meeting. Matron demonstrated the present procedure for managing residents’ personal allowances. A ledger is kept with each residents’ transactions recorded on an individual page. All cash is kept in individual wallets in the safe. Two wallets were checked at random and found to tally with the recorded balance. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 19 When asked if receipts were kept Matron said that they were given to relatives as proof of transactions. This means that the home does not retain proof of the recorded transactions and an audit of the system would not be possible. There was evidence that the Control of Substances Hazardous to Health regulations (COSHH) were being observed. There were notices in the sluices and the cupboards containing hazardous substances were locked. Fire doors leading to the outside were linked to an alarm to alert staff in case a resident wandered. Maintenance records for checks on fire equipment were seen. Risk assessments for individual moving and handling needs were seen in the residents’ personal files. Training records showed evidence that new staff received an induction in safe working practices and this was confirmed by staff that were spoken to. The accident/incident records were seen and showed that since October there have only been four accident/incidents with residents and two relating to staff since last May. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 20 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 3 X 3 Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? None 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) Requirement Timescale for action 07/12/05 2 OP9 13 (2) 3 4 OP18 OP35 13 (6) 16 (2) (l) Where a PRN medication offers a choice of dose i.e. one tablet or two, the number of tablets given must be recorded each time. When a blanket code is used for 07/12/05 the non-administration of medication a written explanation must be given. The present POVA policy must be 31/12/05 updated to reflect county guidelines. The present procedure for 31/12/05 managing residents’ personal allowances must be amended to allow an audit trail. 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 OP7 Good Practice Recommendations Care plans and daily records should show evidence of a holistic approach to care and include psychological needs and moods of the resident. DS0000024530.V271610.R01.S.doc Version 5.0 Page 22 Witnesham Nursing Home 2 3 OP18 OP9 All ancillary staff should have POVA training. A policy for managing the administration of covert medication should be developed. Witnesham Nursing Home DS0000024530.V271610.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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. 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