Care Home: The Grange

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What the care home does well The home benefits from a management team than sets clear goals and standards, and provides good training and support. There is a stable staff group who know the residents well and are aware of their needs and wishes. Staff spoken to were knowledgeable, enthusiastic and said they enjoyed their work and worked well as a team. Residents care planning documentation was detailed, clear, up to date and regularly reviewed. Personal support plans are written to an extremely high standard and individualised to provide staff with maximum information and guidance. Documentation reflects the staff and managers hard work to ensure that residents` independence is promoted and they are offered a choice in many aspects of their lives. The home is clean, well decorated and well maintained. There is a choice of attractive communal areas, and each wing has its own living/dining area and kitchen. All bedrooms have en suite facilities, and are large enough for residents to personalise them and bring their own furniture. Residents spoken with expressed a high degree of satisfaction with the accommodation and with the levels of care provided. Several residents commented that the home was always kept very clean. Staff were observed treating residents with kindness and sensitivity. There is a well established `key worker` system. There are regular residents meetings where residents can ask questions and air their views. The home was described as `brilliant`; `the staff have made me feel very happy and comfortable and look after all my needs`, `I couldn`t wish for anything better`.Residents said the food was `excellent` and that they enjoyed their meals. The menu showed variety, and residents said they were consulted about their preferences. The home follow Derbyshire County Council`s safe guarding adults and recruitment and selection procedures, and there is a corporate complaints procedure. There is a well established system of quality assurance that shows year on year improvement with all residents and relatives saying that the support they receive from staff is good or excellent. What has improved since the last inspection? An outdoor ramp has been provided to improve access to the exterior of the building and enable convenient access to the some areas of the garden. CARE HOMES FOR OLDER PEOPLE Grange (The) 88 Southgate Eckington Sheffield South Yorkshire S31 9FT Lead Inspector Denise Bate Key Unannounced Inspection 5th January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grange (The) DS0000035808.V324306.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. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange (The) Address 88 Southgate Eckington Sheffield South Yorkshire S31 9FT 01246 348644 01246 348601 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) www.derbyshire.gov.uk Derbyshire County Council Leshia Kathleen Bunt Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: The Grange is a purpose built care home registered to provide personal care and accommodation for up to 25 older people. The home is located in the village of Eckington close to a number of shops including a supermarket, chemist and post office. There are three lounge / dining areas, one on each wing of the home. A kitchenette is adjacent to each lounge for the provision of drinks and snacks. The home is served by a central kitchen and laundry. There are 25 bedrooms offering single accommodation with en suite facilities including a shower. A conservatory provides additional seating and dining space. Fees are up to £364 per week for permanent service users, but a range of prices for short term care service users. Extra charges are made for hairdressing, chiropody, magazines, newspapers and contributions towards outings. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over five hours. During the inspection seven residents, one relative, and two staff members were spoken with. The manager and a deputy manager were present during the inspection and provided assistance and information. Written information was provided by the manager prior to the inspection. Ten surveys were received prior to the inspection providing feedback on the service. A number of records were examined, including care planning documentation, minutes of meetings, regulation 26 visit records, staff files and medication records. Four residents were case tracked. A tour of the building took place. What the service does well: The home benefits from a management team than sets clear goals and standards, and provides good training and support. There is a stable staff group who know the residents well and are aware of their needs and wishes. Staff spoken to were knowledgeable, enthusiastic and said they enjoyed their work and worked well as a team. Residents care planning documentation was detailed, clear, up to date and regularly reviewed. Personal support plans are written to an extremely high standard and individualised to provide staff with maximum information and guidance. Documentation reflects the staff and managers hard work to ensure that residents’ independence is promoted and they are offered a choice in many aspects of their lives. The home is clean, well decorated and well maintained. There is a choice of attractive communal areas, and each wing has its own living/dining area and kitchen. All bedrooms have en suite facilities, and are large enough for residents to personalise them and bring their own furniture. Residents spoken with expressed a high degree of satisfaction with the accommodation and with the levels of care provided. Several residents commented that the home was always kept very clean. Staff were observed treating residents with kindness and sensitivity. There is a well established ‘key worker’ system. There are regular residents meetings where residents can ask questions and air their views. The home was described as ‘brilliant’; ‘the staff have made me feel very happy and comfortable and look after all my needs’, ‘I couldn’t wish for anything better’. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 6 Residents said the food was ‘excellent’ and that they enjoyed their meals. The menu showed variety, and residents said they were consulted about their preferences. The home follow Derbyshire County Council’s safe guarding adults and recruitment and selection procedures, and there is a corporate complaints procedure. There is a well established system of quality assurance that shows year on year improvement with all residents and relatives saying that the support they receive from staff is good or excellent. 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 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. Grange (The) DS0000035808.V324306.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 Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out on prospective residents to ensure that the home can appropriately meet their needs. EVIDENCE: Copies of assessments carried out by social services staff were seen on care planning documentation of all case tracked residents. In addition potential residents have a visit to the home and an assessment is completed after that visit. Copies of day visit assessments were seen on the files of case tracked residents. Several residents spoken to had recently moved in, coming from a home that had recently closed down. They felt pleased with their choice of the Grange, and felt they had been welcomed and supported, ‘I visited before I came and I feel I have made the right choice’. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care at the present time. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans are completed in detail and are highly individualised to demonstrate that residents’ health, personal and social care needs are being fully met. EVIDENCE: The four case tracked residents had excellent care planning documentation covering all aspects of care and including risk assessments. Items in files included the photo of the resident, care plans, needs assessment, copies of reviews, personal service plans, risk assessments (moving and handling, falls prevention, nutrition), weight monitoring, health care professional visits, monthly reports written by key workers, preferred form of address and how individual rights and choices were to be promoted including individual routines, last wishes details, and detailed day to day logs. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 11 Personal service plans were excellent, being clearly written and resident focussed. All aspects of care were covered in detail and indicated what was important to a particular resident, e.g. how they liked their belongings arranged in their bedrooms. There was clear guidance on how to encourage independence for individual residents, and a recognition that care needs could fluctuate. Detailed information was given about daily routines, e.g. getting up in the morning, where people liked to sit. There were frequent up dates and cross referencing between the personal service plan and monitoring systems and risk assessments. Where the residents communication was poor, staff were given detailed advice on how to look for individual signs that the resident was comfortable and happy. The personal handling risk assessment was thorough, resident focussed, and updated regularly. Care plans and personal service plans had been signed by residents. Family involvement and consultation was noted on care planning documentation. The personal service plans are used as a working tool, well presented, written in clear language, and could be used in an emergency by people who are not familiar with its content. It is understood that there are about to be some corporate changes to the care planning documentation and the home are considering how to adapt these and ensure that they continue to have the current high standard of individualised and detailed guidance on care planning documentation. The home have an efficient system of communication between staff shifts, and of ensuring consistency of care through a communication book. All aspects of residents health needs and medication were clearly presented and records were up to date, detailed and consistent. There was regular monitoring of weight, nutrition and tissue viability and these were clearly updated. Changes in medication were clearly recorded. Some documentation had been brought with residents from a previous home, and the changeover to the Grange was recorded. Residents said they had regular access to health care professionals when needed. A relative said the home were very good at communicating and ‘they have contacted us straight away when anything has happened’. There is a separate medication room with a medication trolley, lockable fridge and a controlled drug cabinet. The home uses the monitored dosage system. The medication records of some case tracked residents were seen and found to have been recorded correctly. There were sample signatures for staff dispensing medication, who had all received training. The date of opening was recorded on eye drops. The manager reported a good relationship with the supplying pharmacist who visits on a regular basis, and copies of the reports were made available. These found the arrangements at the home satisfactory. The home have access to medication reference books to provide information about particular drugs and their uses and side effects. On the day of inspection Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 12 there were no residents who administered their own medication, but the home have a system of risk assessment which is used when this situation arises. Staff were observed treating residents with dignity and respect in carrying out day to day tasks. There was a great deal of praise for the staff both on the day of inspection and in the questionnaires received from residents. The staff were described as ‘first class’, ‘like one of the family’, ‘the staff are friendly, they can’t do enough for you’. Another resident said she was ‘highly satisfied’ with the care she received. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A varied programme of activities, outings and entertainment are provided that suit the expressed preferences of residents. This assists in contributing to a pleasant atmosphere and the overall good level of satisfaction for service users. Dietary needs of residents are extremely well catered for with a balanced and varied selection of food available that meets service users’ tastes and choices. EVIDENCE: The recent quality assurance exercise indicated that residents are very satisfied with the range and variety of activities offered, although the home hope to improve these further. Regular activities include craft, quizzes, monthly outings, in house entertainment, bingo, shopping trips, chair based exercises, reminiscence, IT groups, theme evenings and religious services. Residents enjoy seasonal celebrations and birthdays, and particularly enjoy outings, ‘I like keep fit, bingo and going on trips’. The home has contacts with Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 14 local community groups. Residents spoken to had enjoyed Christmas. Most residents are local, and reflect the culture of the local community. Several residents and staff have known each other for many years, contributing to continuity and understanding. It was confirmed by residents and relatives that visitors to the home are welcomed. Most residents have contact with relatives and friends and some go out on a regular basis. Residents can see either in their bedrooms, or the conservatory or one of the lounges. Residents meetings are held on a monthly basis. Some residents spoken to said they attended the meetings regularly and felt able to express their opinions. Residents and relatives spoken to were extremely complimentary about the standard of catering, and the choice of menus available, ‘I enjoy the food’, ‘you couldn’t better the food’, ‘I have a special diet and am always offered a choice’. One of the cooks also does some care shifts, and all catering staff have a good knowledge of residents likes and dislikes and any special diets. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear and accessible complaints and safeguarding adults procedures are in place to ensure residents can be confident that any issues raised would be acted on effectively and promptly. EVIDENCE: There is a corporate complaints procedure, although most relatives and residents prefer to raise issues on a more informal basis. The manager is viewed by residents and relatives as approachable and responsive. There have been no formal complaints recorded. Residents all emphasised they ‘had nothing to complaint about’, but if they were worried about anything would talk to the manager or the staff. Derbyshire County Council has clear procedures for dealing with the safety of residents and safeguarding them from harm. Staff spoken to showed an awareness of safeguarding adults issues and would pass any concerns on to their line manager. Training in safeguarding adults has been provided for staff. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This home is purpose built and provides residents with an attractive, modern and well maintained place to live. EVIDENCE: The Grange is a comfortable purpose built home that provides a high standard of accommodation. The home is organised into ‘wings’ with a lounge/dining area, a separate kitchen and bathrooms and toilets are sited on each ‘wing’. During this inspection communal areas of the home were seen and four residents bedrooms seen. There is a regular programme of routine maintenance and renewal of the building and this is evident in the high standard of accommodation provided internally and externally. A new ramp Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 17 has been fitted in the garden since the last inspection, which now provides access to every part of the garden. Three bathrooms were seen and it was noted that the home have two bathrooms with parker baths. The bathrooms are of a good size and well maintained and attractive. The home is well furnished and provides comfort and choice. Individual bedrooms are personalised and many residents have their own furniture, televisions, music centres etc. Bedrooms have en-suite facilities, including a shower, and most have access to a private garden area where residents can sit out in good weather. Discussions with residents indicated that they were pleased and felt the standard of accommodation more than met their expectations. The recent quality assurance exercise had found that 71 of the residents and relatives rated the comfort of the building as excellent. All areas of the home seen were clean and tidy and residents commented that they felt the standards of cleanliness were excellent, ‘the home is always clean’, ‘it is important to me that standards of cleanliness are good’. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and competent workforce are in place which meet the dependency needs of residents currently accommodated within the home. EVIDENCE: Information on staffing was provided which indicates that there are sufficient staff on duty to meet residents current needs. The manager undertakes formal resident dependency assessments (i.e. high, medium or low dependency) to ensure that staffing levels remain appropriate. There are extra staffing hours available if any specific problems arise or dependency levels increase. As detailed elsewhere in this report, residents and a relative spoken to were unstinting in their praise of the staff. Staff spoken to were enthusiastic, knowledgeable, and enjoyed their work. They took part in both mandatory training and training on specific subjects to enhance their knowledge. Thorough induction had taken place for new staff. They said there was a stable staff group and that they worked together well as a team. Over 90 of staff were trained to at least NVQ level 2. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 19 Three staff files were seen and all had relevant information including CRB checks, references and copies of application forms. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager is suitably qualified and experienced and demonstrates good leadership skills. Staff demonstrate an awareness of their roles and responsibilities, thus ensuring the home is run in the best interests of residents. EVIDENCE: The manager is experienced and suitably qualified to run the home and has a sound knowledge of every aspect of care home management, including effective quality assurance and a commitment to continuous improvement. Staff said that the manager was clear in the standards expected of them and Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 21 effective leadership and guidance is given in respect of staff roles and responsibilities. Good administration systems are in place and there is evidence of regular updating of records. There is good communication throughout the home and between shifts, ensuring that resident care remains appropriate, consistent and resident focussed. There is a clear management and delegation structure with each of the three deputy managers being responsible for one wing of the home. Deputy managers complete personal service plans and review them regularly with the registered manager. Residents and a relative spoke positively about the management team, and felt confident that any matters raised with them would be dealt with. The inspector was informed that the home is visited regularly by a representative of the registered person and copies of Regulation 26 visits were available, indicating that day to day matters are looked into, and action take where appropriate. The quality assurance system is well established and shows improvement year on year. There had been a quality assurance exercise in November which indicated that residents and relatives feel the home provides an excellent over all service, all residents and relatives said that the support they received from staff was excellent or good; ‘I cannot fault the Grange or the wonderful management’. Copies of the feedback information were available throughout the home. Staff confirmed that they have regular supervision and that they find the management team supportive in their approach. Staff feel valued and said that their opinions and suggestions are welcomed. The inspector was informed that at present residents’ personal finance records are kept through Derbyshire County Council’s manual scheme which appears to work satisfactorily. A relative who acted as advocate for a resident said that she was kept informed of any changes and if she had any queries about finances the Central Assessments Team were very helpful. Copies of contracts were seen on residents files. Information on maintenance and health and safety records was provided by the manager in the pre-inspection questionnaire and indicates that matters relating to health and safety are satisfactory. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 22 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 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 3 X X 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 X 3 Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care should be taken to ensure that any changes to the personal service plans to ensure that the excellent quality of information on individual care needs is maintained. Grange (The) DS0000035808.V324306.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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