Ann's Choice
Inspection history, citations, penalties and survey trends for this long-term care facility in Warminster, Pennsylvania.
- Location
- 16000 Ann's Choice Way, Warminster, Pennsylvania 18974
- CMS Provider Number
- 396107
- Inspections on file
- 19
- Latest survey
- August 26, 2025
- Citations (last 12 mo.)
- 4
Citation history
Health deficiencies cited at Ann's Choice during CMS and state inspections, most recent first.
A resident with dementia, hypertension, and atrial fibrillation experienced a fall after a private 1:1 aide, who was only supposed to sit with the resident, attempted a transfer without proper authorization. The facility only provided verbal, not written, information to residents and their representatives about the rule prohibiting private aides from providing direct care.
A quarterly Minimum Data Set (MDS) assessment was not completed within the required timeframe for a resident. The RNAC confirmed that the assessment was not done as mandated by the RAI User's Manual, resulting in noncompliance with assessment regulations.
A resident's discharge MDS assessment contained an incorrectly coded social security number, as confirmed by the RN Assessment Coordinator during record review and staff interview.
Three CNAs did not receive required QAPI training as mandated by facility policy and state regulations. Review of records and staff interviews confirmed the absence of QAPI in-service education for these employees during the review period.
The facility did not notify the State Long-Term Care Ombudsman of emergency transfers and discharges for three residents, as required by policy. A resident was readmitted after hospitalization for hypotension and heart failure, another was hospitalized with septic shock, and a third was admitted with osteopenia and a hip fracture. Staff confirmed the failure to provide the required notices.
A facility failed to create a comprehensive care plan for a resident's respiratory needs, despite a physician's order for oxygen. The resident, with multiple health issues, did not have a care plan addressing their respiratory care, confirmed by the RN Unit Manager. This deficiency was noted during a survey, showing non-compliance with care policies.
A resident with a history of elopement behaviors eloped from the facility due to inadequate supervision. The resident, previously identified as an elopement risk and equipped with a WanderGuard, was admitted to the Skilled Nursing Unit without the device after a hospitalization. The facility's assessment failed to recognize the resident's risk, leading to the elopement incident.
A resident with severe cognitive impairment and multiple medical conditions, including a urinary tract infection, was found to have an indwelling urinary catheter without a physician's order. Facility staff confirmed the absence of the order, indicating a failure in obtaining necessary medical documentation.
A resident with multiple health conditions was prescribed 2L/min oxygen via nasal cannula at night. However, the resident was observed receiving 4L/min, a discrepancy confirmed by the RN Unit Manager and acknowledged by the facility's Administrator and DON, indicating a failure to follow the physician's order.
Failure to Provide Written Notice of Facility Rules Regarding Private Companions
Penalty
Summary
The facility failed to provide residents or their representatives with written information regarding facility rules about private companions not being permitted to provide direct care to residents. Although the facility's policy states that a written description of resident rights will be provided upon admission and upon request, interviews confirmed that only verbal information was given about the restriction on private aides providing direct care. This omission was identified during a review of facility documentation and staff interviews. This deficiency was identified in the context of a resident with dementia, hypertension, and atrial fibrillation who experienced a fall in their room. The incident report revealed that a private 1:1 aide, who was present to sit with the resident, attempted to transfer the resident from bed to wheelchair and subsequently lowered the resident to the floor. The nurse later informed the aide that the resident required a two-person transfer due to their condition. The lack of written communication regarding the facility's rules for private aides contributed to the incident.
Failure to Complete Quarterly MDS Assessment Within Required Timeframe
Penalty
Summary
The facility failed to ensure that quarterly Minimum Data Set (MDS) assessments were completed within the required timeframe for one resident. According to the Resident Assessment Instrument (RAI) User's Manual, a quarterly MDS assessment must have an assessment reference date (ARD) no more than 92 days after the ARD of the most recent assessment, and must be completed within 14 days after the ARD. For one resident, the admission MDS assessment had an ARD of March 31, 2025, but there was no evidence that the subsequent quarterly MDS assessment was completed within the required 90-day period. This was confirmed by the Registered Nurse Assessment Coordinator (RNAC) during an interview, who acknowledged that the quarterly MDS assessment was not completed as required.
Incorrect Coding of Resident Information in MDS Assessment
Penalty
Summary
The facility failed to accurately complete a resident assessment for one of sixteen residents reviewed. Specifically, a review of the clinical record and the discharge Minimum Data Set (MDS) assessment for a resident revealed that the resident's social security number was incorrectly coded in the MDS. This error was confirmed during an interview with the Registered Nurse Assessment Coordinator. The deficiency was identified through both record review and staff interview.
Failure to Provide QAPI Training to CNAs
Penalty
Summary
The facility failed to provide required training on Quality Assurance and Performance Improvement (QAPI) to three Certified Nursing Assistants (CNAs), as identified through a review of facility documents and staff interviews. According to the facility's own policies, all health services employees are required to complete continuing education topics, including QAPI, at the time of hire, annually, or more frequently as required by state or federal regulations. The policy also specifies that education regarding QAPI should be provided to appropriate personnel as needed, with ongoing training determined by supervisors or managers. Despite these requirements, documentation showed that three CNAs did not receive QAPI in-service education during the specified review period. This was confirmed during an interview with the Assistant Nursing Home Administrator, who acknowledged the lack of QAPI training for these employees. The deficiency was cited under state regulations related to the responsibility of the licensee, management, and staff development.
Failure to Notify Ombudsman of Resident Transfers
Penalty
Summary
The facility failed to notify the Office of the State Long-Term Care Ombudsman of initiated emergency transfers and discharges for three residents. The policy titled 'skilled nursing initiated transfer/discharge' dated June 2021 requires facility staff to send a timely copy of the notice of facility-initiated resident transfers or discharges to the Ombudsman or other State-required agencies. However, during a review, it was found that the facility did not provide such notifications for three residents. Resident R60 was readmitted to the facility after hospitalization for hypotension and heart failure. Resident R59 was hospitalized with septic shock, and Resident R111 was admitted to the hospital with osteopenia and a fracture involving the left femoral neck. Interviews with the social worker and the director of nursing confirmed the facility's inability to provide the required notices to the Ombudsman upon request.
Failure to Develop Comprehensive Respiratory Care Plan
Penalty
Summary
The facility failed to develop a person-centered, comprehensive care plan for a resident's respiratory care needs. The facility's policy requires individualized care plans that include resident preferences, strengths, routines, personal and cultural preferences, and clinical needs. However, upon review, it was found that the care plan for a resident with multiple diagnoses, including hypertension, chronic kidney disease, congestive heart failure, and paroxysmal atrial fibrillation, did not address the resident's respiratory care needs, despite a physician's order for oxygen administration. Interviews with the RN Unit Manager confirmed the absence of a comprehensive care plan with measurable objectives and timetables for the resident's respiratory care. The resident was receiving oxygen at a level different from the physician's order, indicating a lack of proper documentation and implementation of care plans. This deficiency was identified during a survey, highlighting non-compliance with the facility's resident care policies and nursing services regulations.
Failure to Supervise Leads to Resident Elopement
Penalty
Summary
The facility failed to provide adequate supervision, resulting in the elopement of a resident identified as R161. The resident, who had a history of elopement behaviors and had previously worn a WanderGuard in the Assisted Living Program, was admitted to the Skilled Nursing Unit without the device. Despite having a documented history of exit-seeking behaviors, the facility's holistic assessment upon admission did not identify the resident as an elopement risk, and thus, a specific Elopement Risk Assessment was not completed. This oversight led to the resident eloping from the facility and being found in the parking lot shortly after. Interviews with staff revealed that the resident's WanderGuard was removed during a prior hospitalization and was not reapplied upon their return to the facility. The receptionist on duty at the time of the elopement was unaware that the resident should have been wearing a WanderGuard, as the resident was not listed as requiring one. The facility's failure to recognize the resident's elopement risk and ensure appropriate safety measures were in place directly contributed to the incident.
Failure to Obtain Physician's Order for Urinary Catheter
Penalty
Summary
The facility failed to obtain a physician's order for an indwelling urinary catheter for a resident, identified as Resident R45. The resident was admitted with multiple diagnoses, including tubule-interstitial nephritis, aftercare following joint replacement surgery, and urinary tract infection, among others. The resident's Admission MDS indicated severe cognitive impairment with a BIMS score of 3. During an observation on October 8, 2024, it was noted that the resident had an indwelling urinary catheter in place, but the clinical record lacked a corresponding physician's order. Further interviews with facility staff, including a licensed nurse and the Unit Manager, confirmed the absence of a physician's order for the catheter. Despite the resident's ongoing use of the catheter, the staff could not provide an explanation for the oversight, indicating a failure in the facility's process to obtain necessary medical orders. This deficiency was noted under 28 Pa Code 211.12(d)(5) Nursing services.
Failure to Administer Oxygen as Prescribed
Penalty
Summary
The facility failed to provide respiratory care in accordance with physician's orders for a resident. The resident, who was admitted with multiple diagnoses including hypertension, chronic kidney disease, congestive heart failure, paroxysmal atrial fibrillation, atherosclerotic heart disease, and mild cognitive impairment, had a physician's order for oxygen to be administered at 2 liters per minute via nasal cannula at night. However, during an observation, the resident was found to have an oxygen level set at 4 liters. This discrepancy was confirmed by the RN Unit Manager and later acknowledged by the facility's Administrator and Director of Nursing, indicating a failure to ensure the resident received the appropriate oxygen rate as per the physician's order.
Latest citations in Pennsylvania
A resident with dementia, psychotic disturbance, mood disturbance, and anxiety, residing on a locked unit with a wander guard, was able to leave the secured area by closely following a housekeeper through coded double doors and out a side door without being noticed. Staff did not check for residents before and after exiting the unit, and the resident left the premises, traveled into the community, and purchased food and a drink before being located by local police and returned without injury. The facility’s elopement policy required monitoring for missing residents and initiation of emergency procedures, but these measures were only implemented after the resident was discovered missing and an elopement alarm was activated.
Surveyors observed that dietary staff did not follow the facility’s personal hygiene policy requiring hair restraints, as two dietary employees worked over uncovered food on the tray line with uncovered mustaches. In the same food preparation area, equipment including a large mixer with an uncovered bowl, a Robot-coupe mixer, and a blender were stored and used beneath window frames with peeling paint, and a nearby window blind had dried food debris along its length. Another window frame above a storage rack of meal trays also had peeling paint, demonstrating unsanitary food storage and preparation conditions.
Surveyors determined that the facility failed to provide required written notices of transfers and discharges to multiple residents and/or their representatives, and did not notify the State LTC Ombudsman when residents were transferred to the hospital after changes in condition or left against medical advice. Record reviews showed repeated absence of documentation that residents or responsible parties received written information about the transfers, and that the Ombudsman was informed. The Administrator confirmed that these notifications were not sent.
The facility failed to address repeated grievances regarding slow responses to resident call bells. The grievance policy required acknowledgment and active resolution of both written and verbal complaints, yet multiple residents reported that call bells often went unanswered for more than 30 minutes. Resident council minutes over several consecutive months documented ongoing complaints about delayed call bell response, and grievance records showed multiple similar complaints over an extended period. The DON and the administrator acknowledged a pattern of complaints about slow call bell responses and confirmed that the facility had not responded to these grievances.
Surveyors found that the facility did not ensure a safe, clean, and comfortable environment on two nursing units, noting a shattered clear plastic fire extinguisher cover in a hallway between resident rooms, holes in bathroom walls, a dented and misshaped room entrance doorframe near the floor, a hole in the wall between resident beds, and dented, crumbling wallboard near a bathroom entrance. These conditions were cited under state regulations for licensee responsibility and management.
A deficiency was identified when a resident’s MDS assessment did not accurately reflect the resident’s need for corrective lenses. The resident had a history of diabetes mellitus and falls and was care planned for impaired vision with a requirement for glasses. Despite this, the MDS indicated that no corrective lenses were needed during the look-back period, while direct observation showed the resident wearing glasses, and the Administrator later confirmed the inaccuracy of the MDS documentation.
A resident with chronic kidney disease and DM was documented on the MDS as alert and frequently incontinent of urine, and the CAA indicated that urinary incontinence should be addressed in the care plan. Review of the resident’s current care plan showed no interventions related to urinary incontinence, and the DON confirmed there was no documented evidence that this identified care area was included in the plan.
A resident with chronic kidney disease, polyneuropathies, and muscle weakness, who had no cognitive impairment and required substantial staff assistance for showers and total assistance for transfers, was scheduled to receive showers twice weekly on the evening shift. Over a 30-day period, there was no documentation that showers were provided, offered, or refused, and the resident reported not having had a shower since admission. The DON confirmed the absence of documentation that shower care was offered or provided, resulting in a deficiency related to nursing services and ADL care.
Surveyors found that staff did not follow multiple physician orders for three residents. A resident with diabetes received ordered insulin even when blood glucose readings were below the ordered hold parameter. Another resident with cerebral palsy, DM, and heart failure had repeated significant overnight weight gains without evidence that the physician was notified as ordered. A third resident with anemia and CKD had ordered CBC and CMP lab tests that were not documented as completed. The DON confirmed there was no documentation that these physician orders were carried out.
Staff failed to follow facility policy and physician orders requiring documentation of non-pharmacological interventions (NPI’s) before administering PRN oxycodone for two residents. One resident with osteoarthritis, hip pain, and diabetes had orders for NPI documentation each shift and PRN oxycodone for moderate to severe pain, yet received the narcotic multiple times in a month without any recorded attempt of NPI’s beforehand. Another resident with a history of stroke, diabetes, hemiplegia, and hemiparesis also had orders to document NPI’s prior to PRN pain medication, but similarly received PRN oxycodone several times without documentation that NPI’s were tried first, resulting in noncompliance with state pharmacy and nursing service regulations.
Failure to Prevent Elopement From Secured Unit
Penalty
Summary
The deficiency involves a resident with unspecified dementia without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety who was admitted to the facility in November 2025 and resided on a locked, secured unit requiring a code to exit. The facility had a written "Wandering and Elopements" policy that directed staff, when a resident was missing, to initiate the elopement/missing resident emergency procedure, determine if the resident was on an authorized leave, search the building and premises if not authorized to leave, and notify administration, the resident’s representative, the attending physician, and law enforcement if the resident was not located. On the date of the incident, the resident closely followed a housekeeper through double doors on the ground floor into a back hallway and then out a side door, leaving the secured unit without authorization. The housekeeper was unaware that the resident had followed through the door, and staff failed to ensure the resident’s safety by not checking for residents before and after exiting the unit. An elopement alarm was later activated after the resident was found to be unaccounted for on the secured unit, and the facility’s established protocols were then initiated, including notification of local law enforcement. The resident was subsequently located off premises by local police, sitting in a relaxed manner, conversing appropriately with officers, holding a beverage, and with no visible injuries, and he denied pain or discomfort. Facility documentation showed that the resident had been able to travel far enough to purchase food and a drink at a restaurant, as evidenced by a receipt from a nearby McDonald’s. A progress note recorded that the resident had been noted not on the unit, an immediate search was conducted, administration and proper authorities were notified, and the resident was returned safely, with a skin check completed and the resident later observed in his room eating dinner. In an interview, the resident stated that it was taking too long to get out of the building, that he waited for an opportunity and took it, and that he wanted to leave and go back to his place. In a separate interview, the Nursing Home Administrator confirmed that staff failed to ensure the resident’s safety by not checking for residents before and after exiting the unit, leading to the elopement from the secured environment.
Unsanitary Food Storage and Staff Hygiene Practices in Dietary Department
Penalty
Summary
The facility failed to store and handle food in a sanitary manner in the dietary department in accordance with its own policy and professional standards. The facility’s “Personal Hygiene” policy dated February 2, 2026, required all staff to wear hair restraints to effectively keep hair from contacting exposed food. During observation of the lunch meal service tray line on April 15, 2026, from 11:30 a.m. to 12:03 p.m., two dietary employees were observed working directly over uncovered food on the tray line with uncovered mustaches. In the same area, the window frame above the shelf where a large mixer with an uncovered bowl, a Robot-coupe mixer, and a blender were stored had peeling paint, while the Robot-coupe mixer and blender were actively being used to prepare resident food. Additionally, the blind in this window frame had dried food debris along its length, and another window frame above a storage rack of resident meal trays also had peeling paint. These conditions were cited under 42 CFR 483.60(i) Food Safety Requirements and 28 Pa. Code 201.14(a) Responsibility of licensee, and had been previously cited on March 26, 2025. No specific residents, medical histories, or clinical conditions were described in the report; the deficiency focused on environmental and staff hygiene practices in the dietary department during food preparation and tray line service.
Failure to Provide Required Written Transfer Notices and Ombudsman Notification
Penalty
Summary
Surveyors found that the facility failed to provide required written notifications of transfers and discharges to residents and/or their representatives, and failed to notify the Office of the State Long-Term Care Ombudsman for six residents who were transferred out of the facility. Clinical record review showed that one resident was transferred to the hospital after a change in condition on December 26, 2025, without documented evidence that the resident or responsible party received written information regarding the transfer or that a copy of the transfer notice was sent to the Ombudsman. Another resident was transferred to the hospital after a change in condition on January 9, 2026, with no documented evidence that the Ombudsman was notified of the transfer. Additional record reviews revealed that three more residents were transferred to the hospital after changes in condition on March 30, 2026, and March 12, 2026, without documentation that the residents and/or their responsible parties or legal representatives were provided written information regarding the transfers, or that the Ombudsman was notified. One resident left the facility against medical advice on February 3, 2026, and there was no documented evidence that the Ombudsman was notified of this transfer. In an interview on April 17, 2026, the Administrator confirmed that notifications of transfers were not sent to the residents and/or their representatives and that written notices of the transfers and discharge were not sent to the Office of the State Long-Term Care Ombudsman.
Failure to Address Repeated Grievances About Slow Call Bell Response
Penalty
Summary
The facility failed to address ongoing grievances related to slow response times to resident call bells, as required by its grievance policy. The policy, last reviewed on February 24, 2026, stated that grievances could be either formal written complaints or verbal complaints to staff, and that the facility was to acknowledge and actively work toward resolution of such complaints. During a confidential resident group interview on April 14, 2026, all four participating residents reported that call bells were answered slowly, often taking more than 30 minutes. Review of resident council minutes from September 8, 2025, through December 11, 2025, showed repeated complaints about slow call bell responses at each monthly meeting, with no evidence that any resident council minutes were recorded in 2026. Additionally, review of resident grievances from October 31, 2025, through March 23, 2026, revealed multiple complaints about slow call bell responses on several dates in late 2025 and early 2026. In an interview on April 17, 2026, the DON and Nursing Home Administrator confirmed there was a pattern of complaints about slow call bell responses and that the facility had failed to respond to those grievances. These findings demonstrate that the facility did not honor residents’ rights to have grievances acknowledged and addressed, despite repeated verbal and written complaints documented through resident council minutes and the grievance process.
Damaged Walls, Doorframes, and Fire Extinguisher Cover Compromise Safe, Homelike Environment
Penalty
Summary
The facility failed to maintain a safe, clean, comfortable, and homelike environment on two of five nursing units, specifically the [NAME] and [NAME] units. During observations conducted over two days, surveyors noted that the clear plastic fire extinguisher cover in the hallway between rooms 135 and 137 was shattered. In one resident bathroom, there were holes on the left and right walls, and the doorframe at the entrance to another resident room was dented and misshaped near the floor. Additionally, there was a hole in the wall between the beds in another resident room, and the wallboard at the bottom of the wall to the right of the entrance to a bathroom in yet another room was dented and crumbling. These environmental deficiencies were directly observed in resident care areas and common hallways and were cited under 28 Pa. Code 201.14(a) regarding the responsibility of the licensee and 28 Pa. Code 201.18(e)(2.1) regarding management responsibilities.
Inaccurate MDS Documentation of Resident’s Need for Corrective Lenses
Penalty
Summary
A deficiency occurred when the facility failed to ensure that the Minimum Data Set (MDS) assessment accurately reflected a resident’s current status. Clinical record review showed that Resident 139 had diagnoses including diabetes mellitus and a history of falls, and the resident required glasses to correct impaired vision. The resident’s care plan documented a problem with impaired vision and indicated that glasses were required beginning March 8, 2022. However, the MDS assessment dated [DATE] documented in Section B (Hearing, Speech, and Vision) that the resident did not require corrective lenses during the previous seven days. On observation on April 14, 2026, at 11:00 a.m., Resident 139 was noted to be wearing glasses. In an interview on April 17, 2026, at 1:00 p.m., the Administrator confirmed that the MDS assessment for this resident was inaccurate, as it did not reflect the resident’s actual need for and use of corrective lenses during the assessment look-back period.
Failure to Include Urinary Incontinence in Comprehensive Care Plan
Penalty
Summary
The facility failed to develop a comprehensive care plan that addressed an identified care area for one resident. Clinical record review showed that this resident had chronic kidney disease and diabetes mellitus, and a Minimum Data Set completed on February 20, 2026, documented that the resident was alert and frequently incontinent of urine. The Care Area Assessment summary dated the same day specified that the resident’s urinary incontinence was to be addressed in the care plan. However, review of the current care plan revealed no evidence that interventions for urinary incontinence were included. In an interview on April 17, 2026, at 10:25 a.m., the Director of Nursing confirmed that there was no documented evidence that this identified care area was addressed in the resident’s care plan.
Failure to Provide Scheduled Showers and Document ADL Care
Penalty
Summary
The facility failed to provide and document assistance with activities of daily living, specifically showering, for one resident who was dependent on staff for this care. The resident was admitted on March 12, 2026, with diagnoses including chronic kidney disease, polyneuropathies, and muscle weakness. A Minimum Data Set assessment dated March 19, 2026, showed the resident had no cognitive impairment, required substantial staff assistance for showers, and was totally dependent on staff for transfers. Facility documentation indicated the resident was scheduled to receive showers on Wednesdays and Saturdays during the evening shift. However, the resident reported on April 14, 2026, that they had not had a shower since admission, and review of the clinical record showed no evidence that a shower had been provided, offered, or refused during the previous 30 days. The DON confirmed on April 16, 2026, that there was no documented evidence that showers were offered or provided to this resident. This deficiency was cited under 28 Pa. Code 211.12(d)(1)(5) related to nursing services.
Failure to Follow Physician Orders for Insulin, Weight Monitoring, and Lab Tests
Penalty
Summary
The deficiency involves the facility’s failure to implement and follow physicians’ orders for three residents. For one resident with diabetes mellitus, a physician ordered Novolog insulin to be administered in the morning prior to breakfast, with instructions to hold the insulin if the resident’s blood sugar was less than 80 mg/dL. Review of the April 2026 MAR showed that staff administered the insulin on three occasions when the resident’s blood sugar was below 80 mg/dL, contrary to the physician’s order. Another resident with cerebral palsy, diabetes mellitus, and heart failure had a physician’s order to be weighed every night shift and to notify the physician if the resident gained more than 2 lbs in 24 hours or 5 lbs in one week. Clinical records showed multiple instances of significant weight gains over 24-hour periods, including gains of 4.7 lbs, 3.4 lbs, 6 lbs, 2.3 lbs, 5.8 lbs, 4 lbs, 2.4 lbs, and 3.3 lbs, without documented evidence that the physician was notified as ordered. A third resident with anemia and chronic kidney disease had a physician’s order for two blood tests (CBC and CMP), but the clinical record contained no documentation that these lab tests were obtained. The DON confirmed there was no documented evidence that care and services were provided in accordance with these physicians’ orders.
Failure to Document Non-Pharmacological Interventions Before PRN Narcotic Administration
Penalty
Summary
Facility staff failed to follow the facility’s pain management policy and specific physician orders requiring documentation of non-pharmacological interventions (NPI’s) and their effectiveness prior to administering as-needed narcotic pain medication for two residents. The policy, last reviewed February 24, 2026, required staff to document NPI’s and their effectiveness for patients receiving pain interventions. For a resident with left knee osteoarthritis, right hip pain, and diabetes, a physician ordered on March 17, 2026, that NPI’s be documented every shift, and on April 6, 2026, ordered oxycodone every four hours as needed for moderate to severe pain. Review of the MAR showed that this resident received as-needed oxycodone 23 times in April 2026 without documented evidence that NPI’s were attempted prior to administration. Another resident with diagnoses including cerebral infarction (stroke), diabetes, hemiplegia, and hemiparesis had a physician order dated February 7, 2026, directing staff to document NPI’s used before administering as-needed pain medication, and an order dated April 3, 2026, for oxycodone every four hours as needed for moderate to severe pain. MAR review revealed this resident received as-needed oxycodone nine times in April 2026 without documented evidence that NPI’s were attempted prior to administration, in violation of 28 Pa. Code 211.9(a)(1) Pharmacy services and 28 Pa. Code 211.12(d)(1)(5) Nursing services.
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