Below average — CMS composite of the measures below.
The next survey window likely opens around February 2027
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at The Oaks-brevard during CMS and state inspections, most recent first.
Surveyors found that the facility repeatedly failed to obtain and document informed consent before initiating psychotropic medications for several residents with dementia, mood disorders, psychosis, and anxiety. Multiple residents with severe cognitive impairment were receiving antipsychotics, antidepressants, antianxiety agents, and mood stabilizers such as olanzapine, haloperidol, quetiapine, lorazepam, trazodone, duloxetine, venlafaxine, lamotrigine, mirtazapine, and fluoxetine without any record that they or their representatives had been informed of the risks and benefits or had consented. Interviews with the Administrator, DON, ADON, MDS nurse, and SW showed that responsibility for obtaining psychotropic consents was shared between the MDS nurse and SW, but they were not consistently notified of new or changed orders, were unclear that consents were required for all psychotropics (not just antipsychotics), and acknowledged that frequent staff turnover and process gaps led to consents "slipping through the cracks."
A cognitively intact resident with an existing DNR order informed the facility of this status at admission, and both the physician orders and EMR documented the resident as DNR. However, the DNR form was not present in the advance directives notebook at the nurse’s station, one of the two locations designated by the facility for such documentation. Nursing staff reported they rely on either the advance directives notebook or the EMR to determine code status, and the Interim DON and Administrator acknowledged that the notebook and EMR were expected to match, but in this case they did not.
Surveyors found that the facility did not consistently provide required Medicare beneficiary notices when Part A skilled coverage ended for two residents. One resident was discharged home on the last covered day without receiving a Notice of Medicare Non-Coverage (NOMNC), and there was no documentation that the notice had been issued. Another resident received and signed a NOMNC and remained in the facility after skilled coverage ended, but did not receive a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN). The MDS Coordinator, who is responsible for issuing these notices based on information from therapy and consultation with the provider, reported that the first notice was overlooked while she was on vacation and that she forgot to issue the SNF ABN for the second resident. The Administrator confirmed the expectations for timely issuance of NOMNCs and SNF ABNs and that these expectations were not met in these cases.
Surveyors found that the facility did not request a PASRR Level II evaluation after a resident with a prior Level I status was later diagnosed with major depressive disorder and PTSD and was receiving antidepressant therapy, despite PASRR guidance requiring further screening when new mental illness diagnoses or treatment changes occur. In addition, for another resident with severe cognitive impairment, multiple serious mental illness diagnoses, and a documented PASRR Level II determination specifying specialized services such as psychological testing and psychiatric evaluation, the facility’s comprehensive care plan did not address or incorporate these Level II PASRR recommendations, which staff acknowledged as an oversight.
The facility failed to have a qualified professional directing the activities program, as both the Activity Director and Life Enrichment Specialist lacked formal training and certification. The AD, who transitioned from a nursing assistant role, relied on online resources and previous calendars without formal guidance. The Life Enrichment Specialist also lacked formal training, having only received informal instruction from the AD. The former Administrator was aware of the issue but did not ensure training, while the current Administrator has begun addressing the deficiency.
The facility failed to address and communicate resolutions to concerns raised by residents during Resident Council meetings over 12 months. Meeting minutes lacked documentation of old business, and residents repeatedly voiced issues related to dietary services, staff behavior, and facility maintenance without receiving feedback or resolution. The Activity Director, responsible for recording minutes, admitted to not having formal training, and there was no formal process for documenting or resolving grievances raised during meetings.
The facility failed to provide scheduled group activities during evenings and weekends, leading to resident dissatisfaction and feelings of boredom and loneliness. The Activities Director worked weekdays only, leaving nursing staff to assist with activities during evenings and weekends, but they were unable to provide sufficient support. Residents expressed the importance of having activities to look forward to, and staff confirmed the absence of scheduled activities during these times.
A resident reported her dentures missing shortly after admission, but the facility failed to follow its grievance policy. Despite notifying staff, the resident did not receive follow-up, and the grievance was not logged or resolved within the required timeframe. The Social Worker admitted to forgetting to complete the grievance report, and the Administrator confirmed the grievance process was not followed, resulting in the resident being discharged without her dentures.
The facility did not follow pharmacy recommendations for securing narcotics in the West Hall Medication Storage Room. The narcotic lock box, containing Lorazepam, was found removable from a locked refrigerator. Staff interviews revealed awareness of the issue, which had been identified in a previous pharmacy report, but no resolution had been implemented.
A resident with a history of migraines did not receive her prescribed PRN migraine nasal spray, Stadol, during her stay at the facility due to a failure in the medication reconciliation process. The NP and ADON did not ensure the medication was entered into the MAR, and the double-check system was not effectively implemented. The resident informed staff of her need for the medication, but it was not addressed, and the facility's records lacked a verified discharge summary.
The facility failed to store narcotics in a permanently affixed compartment in a medication room. The narcotic lock box, containing Lorazepam, was found removable inside a locked refrigerator. The ADON believed the medications were secure due to the locked room and refrigerator. The Consultant Pharmacist and DON acknowledged the issue, which had been noted in a previous pharmacy report, but no resolution had been implemented.
A resident reported being held down by staff and denied bathroom access, but the facility failed to follow its abuse policy. The incident was not immediately reported to APS, and the investigation lacked thorough documentation, including interviews with involved parties. The DON delayed responding, and the accused staff were not immediately suspended, resulting in a deficiency in handling the reported abuse.
A facility failed to properly manage a controlled medication, Acetaminophen-Codeine, for a resident who was discharged. An audit revealed 13 tablets were unaccounted for, and the medication card was missing. Interviews with nursing staff showed inconsistencies in handling the narcotic card, and the facility could not provide the controlled substance card count sheet. The DHS suspected the medication card might have been accidentally discarded, and the missing tablets were never recovered.
Failure to Obtain and Document Informed Consent for Psychotropic Medications
Penalty
Summary
The deficiency involves the facility’s failure to obtain and document informed consent for psychotropic medications prior to initiation for multiple residents. For one resident with generalized anxiety disorder and severe cognitive impairment, the record showed an active PRN lorazepam order with no documentation that the responsible party was informed in advance of the risks and benefits or that consent was obtained. Another resident with major depressive disorder, anxiety disorder, borderline personality disorder, hallucinations, and unspecified psychosis, who had intact cognition and no documented behaviors, was receiving risperidone, duloxetine, and lamotrigine without any record that she or her guardian had been informed of the risks and benefits or had consented to these treatments. A third resident with schizophrenia, anxiety disorder, bipolar disorder, and schizoaffective disorder, with moderate cognitive impairment and no behavioral symptoms, was receiving trazodone, venlafaxine, quetiapine, and haloperidol, again with no documentation that the responsible party had been informed in advance or had consented. Another resident with Alzheimer’s disease, major depressive disorder, anxiety disorder, and insomnia, who was severely cognitively impaired and wandering, was receiving mirtazapine, fluoxetine, lamotrigine, and lorazepam on a routine basis. The electronic medical record contained no documentation that the responsible party had been informed in advance of the risks and benefits of these medications or had consented. A resident with dementia, major depressive disorder, and hallucinations was receiving daily olanzapine for hallucinations, with MDS documentation of severe cognitive impairment and daily antipsychotic use, but there was no record that the responsible party had been informed of the risks and benefits or had consented. Another resident with unspecified dementia, generalized anxiety disorder, major depressive disorder, and cognitive communication deficit, who was severely cognitively impaired and receiving antidepressant, antipsychotic, and anticonvulsant medications routinely, was administered olanzapine, lamotrigine, and trazodone without documentation that the representative had been informed in advance of the risks versus benefits or had consented. Interviews with facility staff revealed systemic process issues contributing to the lack of psychotropic consents. The Administrator stated that the Social Worker (SW) and MDS Coordinator were responsible for obtaining psychotropic medication consents but acknowledged that no consent forms could be found for the identified residents and was unsure where the breakdown occurred. The MDS Coordinator and SW both confirmed they shared responsibility for obtaining consents when new psychotropic medications were ordered or existing orders were changed, but reported they were not always informed of new orders or changes, and that providers sometimes added or changed psychiatric medications without notifying them. The Assistant DON/Interim DON and DON stated they believed consents were required for antipsychotics but were not aware of the need for consents for all psychotropic medications, and both cited frequent position changes and acknowledged that obtaining psychotropic consents had “slipped through the cracks.” Psychiatric Nurse Practitioners documented ongoing psychotropic regimens and stability for some residents, including notes that one resident was stable on olanzapine with no indication for gradual dose reduction, and another was stable on olanzapine, lamotrigine, and trazodone with no medication changes needed. However, despite these ongoing psychotropic treatments and routine administration documented on the MARs, the facility’s records lacked corresponding informed consent documentation for each of the psychotropic medications identified in the survey. Staff interviews consistently confirmed the absence of psychotropic consent forms for the affected residents and an inability to explain precisely where in the process the failure to obtain and document consent had occurred.
Failure to Maintain Consistent DNR Documentation in Designated Locations
Penalty
Summary
The deficiency involves the facility’s failure to maintain a resident’s advance directive documentation in both locations designated by facility policy. A cognitively intact resident, admitted with an existing Do Not Resuscitate (DNR) status, reported that he had informed the facility of his DNR upon admission and understood it to mean that staff would not perform CPR if needed. The resident’s physician orders contained an advanced directive order for DNR, and the electronic medical record (EMR) displayed a DNR status in the advance directive banner at the top of the resident’s EMR page. However, when surveyors reviewed the advance directive notebook kept at the nurse’s station, there was no DNR form on file for this resident, despite the EMR and physician orders indicating DNR status. A nurse stated that she would look either in the advance directives notebook or in the EMR to determine a resident’s code status. The Interim DON confirmed she was responsible for ensuring the notebook matched the EMR and for obtaining provider signatures on DNR forms, and acknowledged that the resident’s DNR form was missing from the notebook. The Administrator also stated that code status information in the advance directives binder and EMR should match and that staff were expected to check either source for code status.
Failure to Provide Required Medicare Coverage and Liability Notices
Penalty
Summary
The facility failed to provide required Medicare beneficiary notices related to the end of Medicare Part A skilled coverage for two residents. For one resident, whose Medicare Part A skilled services ended on 10/31/25 and who discharged home the same day, review of the medical record and the facility’s Beneficiary Notice worksheet showed no evidence that a Notice of Medicare Non-Coverage (NOMNC) was reviewed with or provided to the resident or the responsible party. The MDS Coordinator, who is responsible for issuing NOMNCs and SNF ABNs, stated that therapy staff notify her when skilled coverage is scheduled to end and she then consults with the provider to determine if any additional skilled needs exist before issuing the appropriate notice. She reported that when this resident discharged home, the social worker and financial counselor were covering her duties while she was on vacation and the NOMNC issuance was overlooked. The Administrator confirmed that the MDS Coordinator is expected to issue a NOMNC at least two days before skilled services end and that there was no documentation that this occurred for this resident. For another resident, a NOMNC was discussed with and signed by the resident, indicating that Medicare Part A coverage for skilled services would end on 11/15/25, and the resident remained in the facility after skilled coverage ended. However, review of the medical record revealed no evidence that a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) was reviewed with or provided to this resident. The MDS Coordinator again stated she is responsible for issuing both NOMNCs and SNF ABNs and explained her usual process of being informed by therapy when skilled coverage is ending and then determining if any other skilled needs exist before issuing the applicable notices. She acknowledged that she simply forgot to provide a SNF ABN to this resident when the NOMNC was issued. The Administrator stated that the MDS Coordinator is responsible for issuing a SNF ABN when a resident remains in the facility and/or appeals the NOMNC and that he would have expected this resident to receive a SNF ABN when Medicare Part A skilled services ended.
Failure to Request PASRR Level II Evaluation and Integrate Level II Recommendations Into Care Planning
Penalty
Summary
The facility failed to comply with PASRR requirements for residents with serious mental illness. For one resident with an existing Level I PASRR determination, subsequent psychiatric progress notes documented new diagnoses of chronic, stable major depressive disorder and PTSD, along with treatment with sertraline and ongoing monitoring. The resident’s MDS assessments reflected active diagnoses of anxiety disorder, depression, and PTSD, as well as use of antianxiety and antidepressant medications and moderate cognitive impairment. Despite the PASRR Determination Notification specifying that no further screening was required unless a significant change occurred suggesting a mental illness diagnosis or change in treatment needs, the facility did not submit a request for a Level II PASRR evaluation after these new mental illness diagnoses were identified. The social worker, who was responsible for submitting Level II requests, stated she was not always notified of new mental illness diagnoses and acknowledged that no Level II request was submitted for this resident following the new diagnoses. For another resident with a documented Level II PASRR determination, the facility failed to incorporate the PASRR recommendations into the resident’s care plan. This resident had cumulative diagnoses including major depressive disorder, anxiety disorder, borderline personality disorder, hallucinations, and unspecified psychosis, with MDS findings of severe cognitive impairment, delusions, and frequent behavioral symptoms. A Level II PASRR Determination Notification indicated that nursing placement was appropriate and specified specialized services of psychological testing and psychiatric evaluation. However, review of the comprehensive care plan showed no care plan addressing the Level II PASRR specialized services determination. The MDS Coordinator, who was responsible for developing care plans, confirmed the resident had a Level II PASRR and that a care plan should have been developed, but it was not, which was described as an oversight.
Lack of Qualified Activities Program Leadership
Penalty
Summary
The facility failed to ensure that the activities program was directed by a qualified professional, as neither the Activity Director (AD) nor the Life Enrichment Specialist had received formal activities training or certification. The AD, who had previously worked as a nursing assistant and then as a Life Enrichment Specialist, assumed the AD position in December 2023 without any formal training or certification. She relied on online resources and previous activity calendars to guide her work but expressed a desire for formal training to improve the activities program for residents. Similarly, the Life Enrichment Specialist, who also transitioned from a nursing assistant role, had only received informal training from the AD and had not completed any state training courses or obtained certification. Interviews with the former and current Administrators revealed a lack of oversight and follow-through regarding the training and certification of the AD and Life Enrichment Specialist. The former Administrator acknowledged awareness of the lack of formal training and certification but could not recall why it was not pursued. The current Administrator, who began employment in October 2024, was recently made aware of the issue and had initiated discussions with the regional office to arrange formal training and certification for both staff members. The deficiency had the potential to affect all residents at the facility, as the activities program was not being directed by qualified professionals.
Failure to Address Resident Council Concerns
Penalty
Summary
The facility failed to effectively address and communicate resolutions to concerns raised by residents during Resident Council meetings over a period of 12 out of 14 months. The Resident Council meeting minutes consistently lacked documentation of old business, and there was no indication that previous concerns were read, approved, revised, or resolved. Residents repeatedly voiced issues related to dietary services, staff behavior, and facility maintenance, yet there was no evidence of follow-up or resolution communicated back to the residents. Interviews with residents revealed a shared sentiment that their concerns were not being adequately addressed by the facility staff. Residents expressed frustration over the lack of feedback and resolution to their issues, with some concerns persisting over several months. The Resident Council President acknowledged that while some issues might take time to resolve, the residents would appreciate communication regarding the efforts being made to address their concerns. The Activity Director, responsible for recording the minutes of the Resident Council meetings, admitted to not having received formal training on how to document or address the concerns raised during these meetings. The Director of Nursing and the Social Worker also confirmed that there was no formal process in place for documenting or resolving grievances raised during Resident Council meetings. The previous Administrator did not ensure that the concerns were documented or resolved, leading to a lack of accountability and communication with the residents.
Lack of Evening and Weekend Activities
Penalty
Summary
The facility failed to provide scheduled group activities during evenings and weekends, which was important to the residents. The December 2024 activity calendar showed that activities were only scheduled on weekdays, with no evening or weekend activities except for a church service every other Sunday. The Activities Director, who worked Monday through Friday, was responsible for all activities and relied on nursing staff to assist residents during evenings and weekends. However, the nursing staff was not able to provide sufficient support for activities during these times. Residents expressed dissatisfaction with the lack of scheduled activities during evenings and weekends, leading to feelings of boredom, loneliness, and depression. Resident #4, #44, #51, and #56, all cognitively intact, reported during a resident council meeting that they had no scheduled activities during these times, except for the occasional church service. They emphasized the importance of having activities to look forward to and the negative impact of their absence on their mental well-being. Interviews with facility staff, including a nurse and a nursing assistant, confirmed the absence of scheduled group activities during evenings and weekends. They noted that residents were left to find their own activities, such as watching television or doing puzzles, due to insufficient staffing to assist with activities. The Administrator acknowledged the issue and mentioned the facility's ongoing efforts to hire an activity assistant for evenings and weekends, as well as potential schedule adjustments for the Activities Director.
Failure to Implement Grievance Policy for Missing Dentures
Penalty
Summary
The facility failed to implement its grievance policies and procedures when a resident reported her dentures missing. The resident, who was cognitively intact and admitted for aftercare following joint replacement surgery, informed staff that her dentures had been missing since the day after her admission. Despite notifying multiple staff members, the resident did not receive follow-up regarding the resolution of her grievance. The facility's grievance policy requires grievances to be resolved within three business days, but there was no record of a grievance being filed or resolved within this timeframe. The Social Worker (SW) acknowledged awareness of the missing dentures and stated that the facility investigated missing items. However, the SW admitted to forgetting to complete the grievance report until it was requested. The Director of Nursing (DON) and Activities Director (AD) searched for the dentures, including checking the trash and dumpster, but were unable to locate them. The SW stated that the facility was not liable to replace the dentures as they could not verify how they were lost, and there was no documentation of follow-up with the resident regarding the grievance. The Administrator confirmed awareness of the missing dentures and stated that a grievance report should have been started immediately. However, the grievance was not logged, and the Administrator had not reviewed or signed the grievance report. The Administrator and SW both indicated that the grievance process was not followed as per the facility's policy, resulting in the resident being discharged without her dentures and without a resolution to her grievance.
Failure to Securely Affix Narcotic Lock Box in Medication Storage Room
Penalty
Summary
The facility failed to adhere to pharmacy recommendations for the secure storage of narcotics in one of the medication rooms reviewed. During an observation of the West Hall Medication Storage Room, it was found that the narcotic lock box, which contained four unopened vials of Lorazepam, was inside a locked refrigerator but was not permanently affixed, making it removable. This issue was previously identified in the Consultant Pharmacy report dated November 26, 2024, which noted that controls in the refrigerator were under double lock and key but were in the process of being secured in a non-removable lock box. Interviews with facility staff, including the Assistant Director of Nursing (ADON), the Consultant Pharmacist, the Director of Nursing (DON), and the Administrator, revealed awareness of the issue. The ADON believed the medications were appropriately secured due to the locked room and refrigerator. The Consultant Pharmacist confirmed the need for the narcotic box to be permanently affixed, as noted in the November report. The DON acknowledged the issue had persisted since her hiring in April 2021, and the Administrator admitted ongoing discussions about securing the narcotic box without reaching a resolution.
Failure to Administer PRN Migraine Medication
Penalty
Summary
The facility failed to prevent a significant medication error involving a resident who was admitted with a discharge order for a PRN migraine nasal spray, Stadol, which was not entered into the facility's medication administration record (MAR). The resident, who was cognitively intact and had a history of migraines, did not receive the prescribed medication during her stay at the facility. Despite informing multiple nursing staff and discussing the issue with the doctor, the resident's need for the migraine medication was not addressed. The Nurse Practitioner (NP) and Assistant Director of Nursing (ADON) were involved in the medication reconciliation process but failed to ensure the Stadol order was entered into the system. The NP recalled that the ADON had contacted her for medication reconciliation, and she had not ordered any medications to be stopped. However, the ADON admitted to having trouble entering the order into the computer system and forgot to return to it, likely due to interruptions. The double-check system, which involves another nurse verifying the entered medications, was not effectively implemented, as the ADON was unsure who had performed the second check. The facility's Consulting Pharmacist and Medical Director confirmed that the medication reconciliation process was not completed correctly, as there was no verified discharge summary in the resident's electronic medical record. The Medical Director, who was unaware of the omission, noted that the Stadol order was not continued as intended. The Director of Nursing (DON) and the facility Administrator were also unaware of the missing medication order and the lack of a verified discharge summary in the resident's record.
Narcotic Storage Deficiency in Medication Room
Penalty
Summary
The facility failed to store narcotics in a locked, permanently affixed compartment in one of the medication rooms reviewed. During an observation of the West Hall Medication Storage Room, it was found that the narcotic lock box was inside a locked refrigerator but was not permanently affixed, making it removable. This lock box contained four unopened vials of Lorazepam, a Schedule IV antianxiety medication. The Assistant Director of Nursing (ADON) believed that the medications were appropriately secured since both the medication storage room and the refrigerator were locked. The Consultant Pharmacist confirmed that the narcotic box should be permanently affixed to the refrigerator and noted that this issue had been identified in the November 2024 pharmacy report. The Director of Nursing (DON) acknowledged that the narcotic box had not been permanently affixed since her hiring in April 2021 and was aware of the requirement for it to be secured. The Administrator also acknowledged awareness of the issue and mentioned ongoing discussions about how to affix the narcotic box, but no resolution had been reached.
Failure to Implement Abuse Policy and Conduct Thorough Investigation
Penalty
Summary
The facility failed to implement its abuse policy and procedure in the case of a resident who reported being held down by staff and denied access to the bathroom. The facility's policies required immediate reporting of any allegations of abuse to the administrator and notification of Adult Protective Services (APS), neither of which occurred in this instance. The initial allegation report was marked as an abuse investigation, but APS was not notified, and the investigation lacked thorough documentation, including interviews and statements from involved parties. The resident, who was hard of hearing, reported that three staff members held his arms down and yelled at him not to ring the call light. Despite the report, there was no interview or statement from the resident included in the investigation, nor were there statements from the accused staff members or other relevant personnel. The Director of Nursing (DON) was informed of the incident but did not immediately respond, as the situation was deemed non-urgent. The DON later interviewed the resident, but the description of events changed, and the accused staff members were not immediately suspended. Interviews with staff revealed inconsistencies in the handling of the incident. The Activity Director (AD) and a nursing assistant reported the incident to the DON, but neither was interviewed or asked to provide a written statement. The DON and the former administrator conducted interviews with the accused staff, leading to suspensions, but the investigation was not completed promptly, and APS was not notified. The facility's failure to follow its abuse policy and conduct a timely and thorough investigation resulted in a deficiency in handling the reported abuse incident.
Controlled Medication Mismanagement
Penalty
Summary
The facility failed to maintain effective systems for the identification, storage, and return of a controlled medication, specifically Acetaminophen-Codeine, for a resident who was discharged. The resident had an order for this opioid medication to be administered as needed for severe pain. Upon discharge, the facility did not ensure the remaining medication was properly accounted for and returned to the pharmacy. An audit conducted by the Assistant Director of Health Services (ADHS) revealed that 13 tablets of the medication were unaccounted for, and the medication card was missing. Interviews with nursing staff who worked on the relevant medication cart indicated a lack of clarity and consistency in handling the narcotic card. Some nurses recalled seeing the card, while others did not, and there was no specific recollection of dates or times. The facility was unable to provide the controlled substance card count sheet for the period in question, further complicating the situation. The responsible party for the resident confirmed that the medication was not sent home with the resident, and a prescription was provided upon discharge. The Director of Health Services (DHS) and the ADHS conducted a thorough investigation, including interviews and a review of the medication carts. The DHS suspected that the medication card might have been accidentally discarded during the collection of discontinued medications. Despite efforts to locate the missing tablets, they were never recovered. The facility acknowledged the deficiency and recognized the need for a revised medication handling process to prevent future occurrences.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Brevard
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Transylvania Regional Hospital | 0.4 mi | ★★★★★ | 2 | 0 |
| Sapphire Ridge Health And Rehabilitation | 3 mi | ★★★★★ | 4 | 0 |
| The Greens At Hendersonville | 13.1 mi | ★★★★★ | 2 | 0 |
| Valley Hill Health & Rehab Center | 13.7 mi | ★★★★★ | 0 | 0 |
| The Lodge At Mills River | 13.8 mi | ★★★★★ | 0 | 0 |
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