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Inspection on 13/07/05 for Zapuzino

Also see our care home review for Zapuzino for more information

This inspection was carried out on 13th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The home is a small family run business where staff morale is good, resulting in an enthusiastic workforce that works positively with service users to improve their whole lives. Service users praised all the staff saying they are very friendly and nothing is too much trouble for them. Links with service users family/friends and the local community are encouraged and maintained. The Registered Provider/Manager is supported well by her staff in providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities.The home does not have a set menu for each day as it is depends on the wishes of the service users and this allows them choice. The home does ensure that service users receive a nutritious and varied diet.

What has improved since the last inspection?

The home has devised an infection control procedure for staff to follow when working in the kitchen.

What the care home could do better:

The home`s Statement of Purpose and Service Users Guide is inadequate and does not provide sufficient information for prospective service users to be clear about the services the home provides to meet their needs. Both guides do not meet the requirements of the Care Homes Regulations. The home has failed to improve their procedures for administering medication placing service users at risk. The home has failed to address all the requirements issued by Environmental health in relation to the kitchen. A number of maintenance issues were identified at the inspection and once addressed these will improve the environment for the service users. Since the last inspection the standard of vetting and recruitment practices has declined with appropriate checks not being carried out and potentially leaving service users at risk. The systems for service user consultation in this home are poor with little evidence that service users views are sought or acted upon. The home needs to ensure that all records required by the Care Homes Regulations are in place. This relates to duty rotas and photographs of service users.

CARE HOMES FOR OLDER PEOPLE Zapuzino 205 Alexander Drive Cirencester Gloucestershire GL7 1UH Lead Inspector Sharon Hayward-Wright Unannounced 13 July 2005 10:30 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 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. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Zapuzino Address 205 Alexander Drive Cirencester Gloucestershire GL7 1UH 01285 651057 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Rose Kilby Mrs Rose Kilby Care Home 6 Category(ies) of Old age (6) registration, with number of places Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 9/12/04 Brief Description of the Service: Zapuzino is a small care Home within a large housing estate on the outskirts of Cirencester town. The Home is within a quiet cul de sac and surprisingly unobtrusive. Once inside the Home offers single accommodation for the elderly person who requires assistance and supervision in some of their daily activities. The communal lounge/diner on the ground floor has been enlarged following an extension of a small conservatory area. This now provides the Home with separate dining facilities. Other accommodation consists of one bedroom that is located on the ground floor; this has communal bathing and toilet facilities next door. Five other bedrooms are located on the first floor, accessed by a stair lift and one of these has en-suite facilities, with the other four providing hand wash basins. The home does not have waking night staff and emergency night cover is provided by the Registered Provider/Manager. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours on one day in July 2005. Five service users were spoken with to gain their views on the home and the care provided. Two staff members and the Registered Provider/Manager were also spoken with. Staff were observed going about their duties and interacting with each other and service users. A tour of the premises took place and care and food records, duty rotas, medication and personnel files of new staff were inspected; and requirements from the previous inspection were followed up. Two requirements issued at previous inspections remain outstanding and must now be addressed. Two warning letters have been sent to the Registered Provider/Manager regarding the homes Statement of Purpose and Service Users Guide and quality assurance systems. What the service does well: The home is a small family run business where staff morale is good, resulting in an enthusiastic workforce that works positively with service users to improve their whole lives. Service users praised all the staff saying they are very friendly and nothing is too much trouble for them. Links with service users family/friends and the local community are encouraged and maintained. The Registered Provider/Manager is supported well by her staff in providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 6 The home does not have a set menu for each day as it is depends on the wishes of the service users and this allows them choice. The home does ensure that service users receive a nutritious and varied diet. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 standard(s) 1, 3 & 5 The home’s Statement of Purpose and Service Users Guide is inadequate and does not provide sufficient information for prospective service users to be clear about the services the home provides to meet their needs. Arrangements are in place to ensure service users are not admitted to the home without first having their needs assessed and the opportunity for them or their family/representative to visit the home prior to the service user moving in. EVIDENCE: The home has yet to complete their Statement of Purpose and Service Users Guide as required by the Care Homes Regulations. A warning letter has been sent to the Registered Manager/Provider for this to be addressed as a matter of urgency. One new service user has moved into the home since the last inspection. An assessment of their needs was seen as was a copy of their social services care plans and assessment. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 9 This service user confirmed she had visited the home with her family prior to moving in. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 &10 The home has a clear and consistent care planning system in place to adequately provide staff with the information they need to meet the needs of the service users. Service users have the opportunity to access outside health professionals for their assessed needs. The home has failed to improve their procedures for administering medications and is potentially putting service users at risk. EVIDENCE: Two service users were case tracked; and other care plans were inspected. One service user was new to the home and had only been there 2 days therefore the home is in the process of devising care plans. The other service user was at a day centre, however this service user is waiting for a reassessment of their needs due to medical problems. This service user must be reassessed to ensure all their needs are being met by the home and outside agencies. Care plans inspected had an assessment of their needs, with care plans devised from this. A daily routine plan was seen giving all information from Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 11 care needs to types of drinks the service users like. The Registered Provider/Manager said this proved very useful when they recently used an agency carer. It is recommended that care plans for personal hygiene contain more individualised information about the needs of the service users. Records are maintained of health professional visits as well as on going records. A Community nurse confirmed they visit the home if required. A requirement issued at the last inspection for the home to ensure medication is transported safely around the home during administration has not been addressed. This must be addressed to ensure that potential risks to service users are minimised. Three of the four recommendations made at the last inspection have been addressed. The home must move their medication cupboard out of the kitchen area as the changes in temperature due to cooking etc can damage the medication. The Registered Provider/Manager said she would address this. One member of staff confirmed she has completed training in medication procedure prior to administering medication in the home. The other member of staff on duty said she does not administer medication, as she has not undertaken any training. The Registered Provider/Manager said she works closely with the local pharmacist. Service users confirmed that the staff maintains their privacy and dignity. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Service users lifestyle in the home matches their expectations and links with their family/friends and local community are maintained. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: From discussions with service users they are happy with the activities provided by the home as they can choose how and where they spend their time each day. A number of service users said they attend day centres and where able go out and about with family and friends. Visiting to the home is flexible. The new service user is thinking about whether they will join a day centre once they have settled into the home. Service users said they are able to choose how they spend their time each day. Service users personal possessions were seen in their rooms. A poster advertising advocacy services is in the communal lounge. The home has addressed all but one of the requirements issued at the last inspection in relation to the kitchen, with the improvement of an infection control procedure with staff wearing aprons when working in the kitchen. Evidence was seen of temperature checks of food, fridges and freezers. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 13 The home does not have a structured menu as it depends on the service users and the weather, this is unchanged from previous inspections. Service users are offered a choice if they do not like what is on the menu for the day. Service users can choose what they have for their tea. Records are maintained of the food provided. Service users all said they are happy with the food provided and enjoyed the meal provided on the day of the inspection. None of the service users require any assistance with their meal. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: No standards were assessed in this section, however a recommendation made at the last inspection for the home to devise a policy for safeguarding service users financial affairs has not been addressed. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 standard(s) 19 &26 The standard of the environment within this home is satisfactory and provides service user with an attractive and homely place to live, however several improvements are need to improve the environment for service users and to ensure they are not put a risk. EVIDENCE: A tour of the premises took place and a number of maintenance issues were identified and must be addressed; these are: 1. In the room identified by the service users name initial T; that has the en-suite the toilet frame is discoloured and could pose as an infection control risk and must be changed, the Registered Provider/Manager said she is aware of this. 2. In the room identified by the service users name initial E; the unit housing the sink has damaged doors and again is an infection control risk. 3. In the room identified by the service users name initial K; the doors are missing to the sink cupboard and the draws have been damaged. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 16 4. In the room identified by the service users name initial B; the area of the wall that has been plaster boarded must be decorated. 5. The paint on the wall in the conservatory is peeling and must be repaired. 6. In the communal bathroom on the first floor there are tiles missing from the wall and must be replaced. The home was clean and tidy on the day of the inspection and all service users said they were happy with the cleanliness of the home and their rooms. Infection control procedures have been put in to place in the kitchen. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Staff morale is high resulting in an enthusiastic workforce that works positively with service users to improve their whole quality of life. Since the last inspection the standard of vetting and recruitment practices had declined with the appropriate checks not being carried out and potentially leaving service users at risk. EVIDENCE: All service users spoken to praised the staff in the home saying nothing is too much trouble for them and one service user said ‘you could not get better care in a first class hotel’. The home has set off duty with any changes written in the diary, however there is no record of the set off duty (see standards 31-38 for more detail). The Registered Provider/Manager offers emergency night cover, as at previous inspections the number of staff on duty has not changed. Two carers were on duty during the inspection and the Registered Provider/Manager arrived during the inspection. The home has had one member of staff retire and a new carer has started. However the new carer is leaving due to personal reasons. The Registered Provider/Manager has not undertaken any recruitment checks on this new carer and no personnel file was available. The Registered Provider/Manager said that she knows this carer and this carer previously worked for Social Services. This practice is unacceptable and places the vulnerable service users in the home at risk. This practice must not happen Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 18 again and the home must follow the Care Homes Regulations for recruitment of staff. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 & 37 The Registered Provider/Manager is supported well by her staff in providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. The systems for service users consultation in this home are unsatisfactory with little evidence that service users views are sought or acted upon. The home needs to improve areas of record keeping, ensuring they meet the requirements of the Care Homes Regulations. EVIDENCE: All service users and staff spoken to praised the Registered Provider/Manager saying she is approachable and friendly, with service users saying she will do anything for them. A requirement issued at the last inspection for the home to devise quality assurance and monitoring systems has not been addressed. However service Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 20 users are able to chose their meals. A warning letter has been sent to the Registered Provider/Manager to address this immediately. The home must maintain a copy of the duty roster and a record of hour worked for all staff including the Registered Provider/Manager. The home must also obtain a photograph of the new service user and the other service user discussed at inspection. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 2 1 x x x 2 x Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4&5 Timescale for action The Registered Provider/Manager 18/10/05 must provide the home with a completed Statement of Purpose and Service Users Guide. A copy of both final documents must be supplied to the Commission. Timescales of the 19/7/04 and 1/3/04 were not met. The Registered Provider/Manager 18/10/05 must ensure that the service user discussed at inspeciton is reassessed to ensure the home can meet their needs. A copy of the assessments must be sent to the Commission. The Registered Provider/Manager 18/8/05 must ensure that a safe and secure facility is provided for transporting medication around the home and that the MAR sheets are used as part of the process of adminstering medication. Timescale of the 1/3/05 was not met. The Registered Provider/Manager 1/8/05 must ensure that all medication is locked away and not stored in a normal kitchen cupboard. The Registered Provider/Manager 18/8/05 must move the medication Version 1.20 Page 23 Requirement 2. 7 14(2b) 3. 9 13(2) 4. 9 13(2) 5. Zapuzino 9 13(2) D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc 6. 15 13(4c) 7. 8. 19 27 23(2b) 19 & Schedule 2 cupboard out of the kitchen to ensure medication is stored at the correct temperatures. The Registered Provider/Manager 18/10/05 must address the oustanding requirement issued by Environmental Health to complete the wall covering by the boiler as it is an infection control risk. The Registered Provider/Manager 18/10/05 must address the maintenance issues listed in standards 19-26. Since the introduction of the 18/10/05 POVA scheme, and the amendments to the Care Home Regulations on the 26/7/04 for pre-employment checks on staff, the Home must obtain the following for all staff recruited since this date: Proof of identity, including a recent photograph· Details of criminal offences a) of which the person has been convicted, including any details which have been spent; b) in respect of which he/she has been cautioned by a constable. Criminal Records Bureau disclosure (including a POVA check where applicable). Two written references, including, where applicable a reference relating to the person’s last period of employment, which involved work with vulnerable adults, of not less than 3 months duration. Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why the person ceased to work in their last position unless it is not reasonably practicable to obtain Version 1.20 Page 24 Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc 9. 29 13(6) 10. 37 17 & Schedule 3(2) 17 & Schedule 4(7) 11. 37 such verification. Documentary evidence of any relevant training and qualifications. Full employment history with satisfactory written explanation of reasons for gaps in employment. Evidence of physical and mental fitness for the purposes of the work. Details and evidence of registration with, or membership of, any professional body. The Registered Provider/Manager 20/8/05 must ensure that their recruitment procedure is updated following the amendments to the Care Homes Regulations and the implementation of the POVA list. This is to ensure that service users are not being put at risk of harm or abuse. The Regsitered Provider/Manager 1/9/05 must obtain a photograph of the two service users discussed at inspection. The Registered Provider/Manager 20/8/05 must have a copy of the duty roster of all persons working at the care home and a record of hours actually worked. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Refer to Standard 1 7 Good Practice Recommendations The home should have information avaliable on how service users and their relatives can contact the local Social Services Department and Primary Care Trust. The home should add more individual detail into service users care plans for personal care. Version 1.20 Page 25 3. 4. 5. 9 18 34 The home should purchase a locakble box or trolley to transport their medication safely around the home during administration. The home should devise a policy on how to safe guard service users financial affairs. The home should have a written business and financial plan that is reviewed yearly. Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 26 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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. Extracts may not be used or reproduced without the express permission of CSCI Zapuzino D51_DO3_16662_Zapuzino_v221383_130705_stage4.doc Version 1.20 Page 27 - 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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