Centro Medico Wilma N Vazquez Snf
Inspection history, citations, penalties and survey trends for this long-term care facility in Vega Baja, PR.
- Location
- Road 2 Km 39 5 Bo Algarrobo, Vega Baja, PR 00693
- CMS Provider Number
- 405025
- Inspections on file
- 14
- Latest survey
- December 6, 2024
- Citations (last 12 mo.)
- 0
Citation history
Health deficiencies cited at Centro Medico Wilma N Vazquez Snf during CMS and state inspections, most recent first.
A facility failed to ensure food and drink were palatable and at safe temperatures, as observed during a survey. A resident reported meals served on Styrofoam trays were cold. Test trays showed hot foods like chicken thigh and stew were below 140°F, while cold items like milk and apple sauce were above 40°F. Food temperatures dropped from assembly to serving, and hot foods were uncovered, contributing to the issue.
The facility was found to have deficiencies in food service safety, including an inoperable High Temperature Sanitizing Door-type Dishwasher and dishwashing detergent dispenser, both confirmed by the Nutritional Services Manager. Additionally, food remains were observed on the floor below the food line, indicating inadequate cleanliness and maintenance.
A facility's infection control program was found deficient when an RN failed to perform hand hygiene during multiple medication passes, missing 19 opportunities to wash hands while administering medications to residents. Additionally, expired medical supplies were found on the crash cart.
The facility failed to maintain essential equipment in safe operating condition, affecting all eight residents. Observations included rust on commodes and walkers, and medical tape on a crutch's grab cushion.
The facility was found to have deficient environmental conditions affecting resident safety and comfort. Room temperatures in some areas were below the facility's policy range, with temperatures recorded at 66 and 64 degrees Fahrenheit. Loose grab bars in bathrooms and improperly secured or missing headlight cords behind beds were also observed, impacting the safety and usability of these items for residents.
A facility failed to ensure personal privacy for a resident during Occupational Therapy treatment. The resident was observed sitting on the bed with only clothing from the waist down and a disposable diaper, despite the availability of pajama pants. The nursing supervisor confirmed the responsibility of rehabilitation personnel to dress the resident before treatment. The facility lacked a personal privacy policy, contributing to this deficiency.
A resident with a history of pneumonia and anxiety was found with albuterol pumps at her bedside without proper documentation or a care plan for self-administration. Despite the resident's need to see the pumps to prevent panic attacks, there was no medical order or interdisciplinary care plan addressing this. Facility staff, including the medical director and pharmacist, acknowledged the oversight, and a meeting was planned to discuss the resident's medication management.
The facility did not comply with its policy for labeling and dating food brought by family and visitors for residents. During a survey, it was observed that snacks, including birthday cake, in the residents' refrigerator were not labeled with the required information, such as the resident's initials, room number, and date, as per the facility's policy.
The facility failed to provide resident categorization necessary for determining staffing needs, affecting all residents. The DON was unable to perform the categorization due to the suspension of the responsible supervisor and was unsure of the correct procedure. The facility was not complying with Payroll Based Journal requirements, prioritizing immediate resident needs by reallocating resources from other departments.
The facility did not meet the dietary needs of residents by serving food in Styrofoam containers, which do not maintain the correct temperatures necessary for nourishing and palatable meals.
The facility was found to lack sufficient and qualified staff in the food and nutrition services department, affecting all 24 residents. Observations and interviews revealed the absence of an Administrative Dietitian or Kitchen Manager, as confirmed by the Kitchen Supervisor.
The facility did not ensure sufficient and qualified staff for food and nutrition services. During a survey, the kitchen staffing pattern was requested from the Kitchen Supervisor but was not provided after three days.
The facility failed to meet food service safety standards, with issues including improper defrosting sink maintenance, incorrect preparation of the three-compartment sink, and a non-operational high-temperature dishwasher due to a lack of cleaning product.
The facility failed to submit accurate PBJ data to CMS due to inadequate review and auditing processes. The Administrator acknowledged that errors in nursing hours and service data for the last quarter of 2023 were transmitted without correction, as they were identified post-transmission.
The facility failed to maintain an effective QAPI program, with the last Quality Committee meeting held in July 2022 and no committee established since the resignation of the Director of Quality and Risk Management in August 2023. Despite efforts to review quality indicators, the necessary QAPI and QAA meetings had not been implemented by the time of the survey.
The facility failed to maintain an effective QAPI program, as it did not collect or maintain data, develop quality indicators, or provide evidence of QAPI meetings and participation by key staff. There was no documentation of an Annual Monitoring Plan or quality indicators for 2024.
The facility did not maintain a QAPI program as required, failing to conduct quarterly meetings for the SNF and lacking attendance from all required committee members. The SNF had not had a Quality Committee for over a year, with the last meeting held in July 2022.
During a survey, it was found that two handrails in the main corridor between a room and room 110 were loose, with plastic covers sticking out of their bases. This deficiency was identified through observations, policy reviews, and staff interviews.
The facility was found to have an ineffective pest control program, as evidenced by the presence of seven mouse traps in the dry storage area. A kitchen supervisor reported that a mouse had been found previously, leading to a request for more traps.
The facility failed to ensure compliance with advance directives for two residents with cognitive impairments. One resident, admitted with general weakness, and another with a left hip fracture, both lacked documentation and communication regarding advance directives. The social worker confirmed that neither resident was mentally competent to formulate directives, and the social services department was not informed to coordinate with relatives for medical decisions.
A survey identified multiple deficiencies in the facility's environment and equipment, affecting resident safety and comfort. Issues included rust on beds and chairs, misaligned night table doors, squeaky room doors, and dark spots on floors. Additionally, some rooms lacked necessary furniture, and several commodes had broken armrests with sharp edges. A resident reported their room was too cold, and a holding grip next to a toilet was loose.
The facility did not follow its policy of weighing residents upon admission and weekly, as six residents reported not being weighed upon arrival. Despite the residents' satisfaction with food and appetite, their weights were missing from the log. The clinical dietitian was unaware of any weights taken or issues preventing it, indicating a communication breakdown and policy non-compliance.
The facility failed to maintain a safe and sanitary environment, affecting all 21 residents. Observations included yellow spots on a ceiling, peeling paint, dirty occupational therapy room, and unlabeled refrigerators with mold and dust. Other issues were deteriorated boxes, trash without a lid, dusty wheelchairs, and rusty equipment. The facility lacked documentation of cleaning and temperature logs, compromising infection control.
The facility did not have the results of the most recent survey conducted in 2023 available or posted for residents and the public. The only survey result available was from April 2022, indicating a lapse in compliance with the requirement to keep survey results accessible and up-to-date.
The facility failed to provide a varied activity program for all residents, as the activity calendar was empty for April. The sole recreational therapist cited a lack of materials and staff as reasons for limited activities, which were restricted to individual pursuits like lectures and puzzles.
The facility did not develop a required Facility Assessment, which is crucial for determining necessary resources for resident care during regular operations and emergencies. During a survey, the Administrator, in position for 1.5 years, admitted to not finding the assessment and planned to initiate its development. This deficiency potentially impacted all 21 residents.
Failure to Maintain Safe and Appetizing Food Temperatures
Penalty
Summary
The facility failed to ensure that food and drink provided to residents were palatable, attractive, and maintained at a safe and appetizing temperature. This deficiency was identified during an initial tour observation, resident interviews, and staff interviews, as well as through the review of policies related to meal assembly and delivery. Specifically, a resident reported that meals were consistently served on disposable Styrofoam trays and were cold upon consumption. Observations during test tray assessments confirmed that food items were not maintained at appropriate temperatures, with hot foods such as chicken thigh and stew with rice falling below the required 140°F, and cold items like milk and apple sauce exceeding the 40°F threshold. Further investigation during the assembly of food trays revealed that while some food items initially met temperature standards, they were not maintained at these temperatures by the time they were served. For instance, vegetable mash and meat temperatures dropped significantly from the assembly line to the test tray assessment. Additionally, hot foods were not covered, contributing to the temperature discrepancies. The use of Styrofoam trays for all meal components, both hot and cold, was noted, which may have contributed to the inability to maintain appropriate temperatures. The clinical nutritionist confirmed the facility's temperature parameters for hot and cold foods, highlighting the failure to adhere to these standards.
Food Service Safety Deficiencies
Penalty
Summary
The facility failed to adhere to professional standards for food service safety, as observed during a survey conducted from December 4 to December 6, 2024. The High Temperature Sanitizing Door-type Dishwasher was found to be inoperable, a condition that had persisted since September 2024, as confirmed by the Nutritional Services Manager. Additionally, the dishwashing detergent and Arrex dispenser were also inoperable, with the automatic dispenser having been broken since October 2024. Furthermore, food remains were observed on the floor below the food line, indicating a lack of proper cleanliness and maintenance in the kitchen area.
Infection Control Deficiencies During Medication Pass
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by multiple observations during a medication pass. A registered nurse (RN) did not wash her hands or disinfect the medication cart before initiating the drug pass. During medication preparation for a resident, the RN donned gloves without prior handwashing, picked up a jar of gum from the floor, and continued administering medication without changing gloves or washing hands. The RN missed five opportunities to wash her hands during this process. Additionally, during a subsequent medication pass, the RN failed to perform hand hygiene in 19 instances while administering medications to five patients. Furthermore, an inspection of the crash cart revealed expired medical supplies, including three Vacuproo safety blood collections and one blood gas item, with expiration dates of June 2024 and May 2023, respectively.
Failure to Maintain Safe Equipment Conditions
Penalty
Summary
The facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition, as observed during a survey conducted from December 4 to December 6, 2024. The deficiency was noted in several areas, including rust on commodes in the bathrooms of specific rooms, rust on the base of three out of three four-contact-point walkers, and medical tape on the grab cushion of one out of four crutches. These issues were identified in areas affecting all eight residents receiving services, indicating a failure to ensure the safety and proper maintenance of essential equipment.
Deficient Environmental Conditions in Resident Rooms
Penalty
Summary
The facility failed to ensure a safe, clean, comfortable, and homelike environment for its residents, as observed during a survey conducted over three days. The survey revealed that room temperatures in certain resident rooms were below the facility's policy range of 71 to 80 degrees Fahrenheit, with temperatures recorded at 66 and 64 degrees Fahrenheit in two rooms. Additionally, grab bars in the bathrooms of three rooms were found to be loose, posing a potential safety risk. Furthermore, the headlight cords behind beds in two rooms were either tied with ribbons or missing, which could affect the residents' ability to use them effectively.
Failure to Ensure Resident Privacy During Care
Penalty
Summary
The facility failed to ensure personal privacy for residents during care, as observed during a survey conducted from December 4 to December 6, 2024. Specifically, a resident receiving Occupational Therapy treatment was observed sitting on the edge of the bed with only clothing from the waist down and a disposable diaper, despite the curtain being drawn. The nursing supervisor confirmed that pajama pants were available for the resident, and it was the responsibility of the rehabilitation personnel to ensure the resident was dressed before treatment. Additionally, the Director of Nursing stated that the facility lacked a personal privacy policy, contributing to the deficiency.
Failure to Document and Plan for Resident's Self-Administration of Medication
Penalty
Summary
The facility failed to ensure proper documentation and planning for a resident's self-administration of medication. A female resident with a history of pneumonia, muscle deconditioning, post-hip arthroplasty, depression, and anxiety disorder was observed with several albuterol pumps at her bedside. The resident expressed a need to see the pumps upon waking to prevent panic attacks. However, there was no documented plan of care or medical order allowing the resident to have the medication at her bedside for self-administration. The facility's policy on self-administration of medications was not appropriately applied, as evidenced by the MDS coordinator providing a hospital policy that did not align with the resident's needs. Interviews with facility staff, including the medical director and pharmacist, revealed that attempts to remove the pumps were unsuccessful due to the resident's refusal. The medical director acknowledged the resident's reliance on nursing staff for most activities except for the self-administration of albuterol. The pharmacist confirmed that the medication regimen review did not account for the resident's self-administration of albuterol, and there was no interdisciplinary care plan addressing this issue. The facility planned to hold a meeting to discuss the appropriateness and safety of the resident's self-administration of the medication.
Failure to Label and Date Food in Residents' Refrigerator
Penalty
Summary
The facility failed to adhere to its policy regarding the use and storage of foods brought to residents by family and other visitors, which is essential for ensuring safe and sanitary storage, handling, and consumption. During a review of the facility's policy titled 'Almacenaje, Limpieza y Mantenimiento de Neveras Departamentales' (Storage, Cleaning and Maintenance of Departmental Refrigerators), it was noted that all food in the refrigerator must be labeled with the resident's initials, room number, and date. However, at approximately 9:30 AM, surveyors observed that some snacks, including birthday cake and other snacks, were present in the residents' refrigerator without any date or labeling, indicating a breach of the facility's policy.
Failure to Provide Resident Categorization for Staffing Needs
Penalty
Summary
The facility failed to provide evidence of resident categorization of dependence needs, which is necessary to determine the appropriate number and type of nursing staff required on a 24-hour basis to meet the needs of all residents. This deficiency affected all 21 residents in the facility. During an interview with the Director of Nursing (DON), it was revealed that the categorization was not available because the facility supervisor, who was responsible for this task, had been suspended. The DON was attempting to perform the categorization but was unsure of the correct procedure and frequency, whether daily or weekly. Additionally, the DON acknowledged that the facility was not complying with the Payroll Based Journal requirements, as they were prioritizing meeting the immediate needs of the residents by reallocating resources from other hospital departments when necessary. Despite these efforts, the facility was unable to provide the required categorization during the survey period.
Failure to Ensure Proper Food Temperature for Residents
Penalty
Summary
The facility failed to provide each resident with a nourishing, palatable, well-balanced diet that meets their daily nutritional and special dietary needs. During the observation of the food service, it was noted that food was served in Styrofoam containers. These containers do not ensure that food will reach residents at the correct temperatures, which is essential for maintaining the nutritional quality and palatability of the meals provided to residents.
Insufficient Qualified Staff in Food and Nutrition Services
Penalty
Summary
The facility failed to ensure sufficient and qualified staff with the appropriate competencies and skill sets to carry out food and nutrition services for all 24 residents admitted. During observations and interviews conducted over two days, it was found that the facility lacked an Administrative Dietitian or a Kitchen Manager. This deficiency was identified after reviewing the personnel roster with the Kitchen Supervisor.
Insufficient Qualified Staff in Food and Nutrition Services
Penalty
Summary
The facility failed to ensure there was sufficient and qualified staff with the appropriate competencies and skill sets to carry out food and nutrition services. During a survey conducted from April 8, 2024, to April 9, 2024, observations of the kitchen, a review of policies and procedures, and staff interviews were performed. It was noted that the kitchen staffing pattern was requested from the Kitchen Supervisor on April 7, 2024, at 11:00 AM, but it was not provided after three days of the survey.
Food Service Safety Deficiencies
Penalty
Summary
The facility failed to adhere to professional standards for food service safety, as observed during a survey conducted from April 8 to April 9, 2024. The inspection revealed that the defrosting sink hoses were covered with cloths, which can accumulate water and promote bacterial growth. Additionally, the facility did not follow its policy for the preparation of the three-compartment sink. The first compartment was not prepared with the required temperature of 110 degrees using VEL dish soap, and the third compartment, intended for sanitation, did not meet the required Arrex concentration of 200 ppm, measuring only 100 ppm instead. Furthermore, the high-temperature dishwasher was found to be non-operational due to a lack of cleaning product, further compromising food safety standards.
Inaccurate PBJ Data Submission to CMS
Penalty
Summary
The facility failed to ensure the submission of complete and accurate direct care staffing information to CMS, as required by the Payroll Based Journal (PBJ) system. During an interview, the Administrator admitted that the facility was not properly reviewing and auditing the PBJ data and other verifiable information before transmitting it to CMS. This oversight led to the transmission of erroneous data for the last quarter of 2023, specifically related to nursing hours of care and other incongruent information regarding days and services provided. The errors were identified only after the data had been entered and transmitted, making it impossible to correct them for that quarter.
Failure to Maintain QAPI Program
Penalty
Summary
The facility failed to maintain an effective Quality Assurance and Performance Improvement (QAPI) program, as required for long-term care facilities. During a survey conducted from April 7 to April 9, 2024, it was discovered that the last Quality Committee meeting for the Skilled Nursing Facility (SNF) was held on July 20, 2022. The SNF did not have a Quality Committee for over a year, and the position of Director of Quality and Risk Management has been vacant since August 13, 2023. The administrator acknowledged the absence of a QAPI and QAA committee and mentioned efforts to review quality indicators and establish meetings, but these had not been implemented by the time of the survey. Additionally, the Quality and Risk Manager Coordinator, who was appointed as a full-time Quality and Assurance Coordinator on November 1, 2022, confirmed that since the resignation of the previous Director of Quality and Risk Management, no QAPI and QAA committee had been established. Despite the creation of a committee to transform Institutional Programs in September 2023, the facility had not yet set up the necessary QAPI and QAA meetings, leading to the deficiency noted in the survey.
Failure to Maintain Effective QAPI Program
Penalty
Summary
The facility failed to maintain a Quality Assurance and Performance Improvement Program (QAPI) as required. During the survey conducted from April 7 to April 9, 2024, it was observed that the facility did not collect and maintain data or develop indicators to monitor and improve the quality of life, quality of care, and safety. The facility was unable to provide documentation or evidence of quality indicators that the QAPI committee had identified, monitored, and evaluated for improvement. Additionally, there was no evidence that key facility staff from each department attended and actively participated in the QAPI meetings. The facility also failed to provide evidence of an Annual Monitoring Plan, quality indicators, meetings, and other relevant information for the year 2024.
Failure to Maintain QAPI Program and Conduct Required Meetings
Penalty
Summary
The facility failed to maintain a Quality Assurance and Performance Improvement Program (QAPI) as required by Federal Regulations. Specifically, the facility did not conduct quarterly meetings exclusively for the Skilled Nursing Facility (SNF), and when meetings were held, not all required committee members were in attendance. During an interview with the Hospital Administrator and the Skilled Nursing Facility Administrator, it was revealed that the SNF had not had a Quality Committee for more than a year. The last meeting of the Quality Improvement Committee for the SNF was conducted on July 20, 2022.
Loose Handrails in Corridor
Penalty
Summary
The facility failed to equip corridors with firmly secured handrails on each side, as observed during a survey conducted on 04/08/2024. Specifically, two handrails in the main corridor between room [ROOM NUMBER] and 110 were found to be loose, with plastic covers sticking out of their bases. This deficiency was identified through observations of the physical environment, a review of policies and procedures, and interviews with facility staff.
Pest Control Deficiency in Facility
Penalty
Summary
The facility failed to maintain an effective pest control program, resulting in the presence of pests and rodents. During a survey conducted on April 8, 2024, from 8:00 AM to 5:30 PM, seven mouse traps were observed in the dry storage area. The Kitchen supervisor, identified as employee #17, stated during an interview that a mouse had been found previously, prompting a request for additional mouse traps.
Failure to Ensure Advance Directives for Residents with Cognitive Impairments
Penalty
Summary
The facility failed to comply with the requirements regarding advance directives for residents, as identified in two out of fifteen records reviewed. The policy mandates that every resident admitted to the facility should be informed about advance directives by the admission personnel. However, in the case of a female resident admitted with a diagnosis of general weakness, the facility did not have any information related to advance directives, nor was there any evidence that the admission department provided information to the resident's relatives about the right to accept or refuse medical or surgical treatment. The social worker confirmed that the resident was not mentally competent to formulate advance directives and that the social services department was not informed to coordinate with the relatives for establishing advance directives. Similarly, another female resident admitted with a left hip fracture also lacked documentation related to advance directives. The social worker noted that this resident experienced episodes of altered mental status, rendering her unable to formulate advance directives. Again, the social services department was not informed to coordinate with the resident's relatives for medical decision-making. The facility did not have a mechanism to ensure that changes in mental status were communicated to relatives or resident representatives, and no documentation was found in the medical records regarding medical treatment decisions or the formulation of advance directives.
Deficiencies in Facility Environment and Equipment
Penalty
Summary
The facility failed to maintain a safe, clean, comfortable, and homelike environment for its residents, as observed during a survey conducted over two days. Several deficiencies were noted, including night tables in rooms 107-A, 107-B, and 110 with misaligned doors, and rust present on the metal areas of beds and bedside rest chairs in rooms 104-B, 110-A, and another unspecified room. Additionally, doors in rooms 107, 108, and 110 were found to squeak when opened, and a weight scale was observed with rust. Floors in rooms 104, 107, 108, and 110 had dark spots, and the wall area around the air conditioning unit showed signs of moisture pockets. A closet door in one room lacked a knob, and another room was missing a night table, which a resident expressed a desire for to organize personal belongings. Further observations revealed that a resident in one room complained about the room being too cold. Throughout the facility, beds were noted with rust and some had broken components, such as handrails. Three commodes in rooms 103, 106, and 115 were found with broken armrests and sharp edges, posing a potential hazard. Additionally, a holding grip next to a toilet in one room was observed to be loose. These deficiencies indicate a failure to uphold the residents' right to a safe and comfortable living environment, potentially affecting 19 out of 21 residents in the facility.
Failure to Monitor Resident Weights Upon Admission
Penalty
Summary
The facility failed to adhere to its policy of weighing residents upon admission and weekly thereafter, as evidenced by interviews and record reviews conducted between 04/07/2024 and 04/09/2024. Six residents, all admitted with various orthopedic conditions such as hip and knee replacements, reported that their weights were not taken upon admission. This was corroborated by the absence of their weights in the facility's weight log. The residents, however, expressed satisfaction with the food and their appetite, indicating they did not perceive any weight loss since admission. The facility's policy, reviewed with the clinical dietitian, clearly mandates that residents' weights be recorded at admission and weekly. Despite this, the clinical dietitian was not informed of any weights taken at admission or any issues preventing the weighing of residents. This lack of communication and adherence to policy resulted in a systematic failure to monitor the residents' weight status, which is crucial for maintaining their health while receiving services at the facility.
Infection Control and Environmental Deficiencies
Penalty
Summary
The facility failed to maintain a safe and sanitary environment, which was observed during a survey conducted from April 7 to April 9, 2024. The survey identified multiple deficiencies, including yellow spots on the ceiling above a resident's bed, peeling paint on bed rails, and a dirty occupational therapy room with dust and stains. Additionally, the facility's refrigerators were found to be unlabeled, lacking daily temperature records, and containing raw meat in unlabeled containers. The refrigerators also had ice buildup, mold, and dust on the exterior. Other issues included deteriorated cardboard boxes, trash disposal without a bag or lid, dusty wheelchairs, and moldy shelves with various items, including edibles and protective gowns. Further observations revealed exposed computer cables, a column with missing baseboard and paint, and a door frame with open spaces. The occupational therapy room contained rusty equipment and lacked documentation of cleaning and disinfection after use. The facility also failed to provide evidence of daily temperature logs for the occupational therapy room. These deficiencies had the potential to affect all 21 residents receiving services at the facility, as the environment was not maintained to prevent the development and transmission of communicable diseases and infections.
Survey Results Not Accessible to Residents and Public
Penalty
Summary
The facility failed to ensure that the results of surveys conducted by Federal or State surveyors, along with any plans of correction, were available for review by any individual upon request. During initial tours, it was observed that the facility did not have the results of the most recent survey conducted in 2023 available or posted for residents and the public. The only survey result available was from April 2022, indicating a lapse in compliance with the requirement to keep survey results accessible and up-to-date.
Deficiency in Activity Program for Residents
Penalty
Summary
The facility failed to maintain an activity program that meets the needs of all 24 admitted residents, as observed during a survey. During an initial observational tour, it was noted that the monthly activity calendar in the main hallway was empty for April 2024. This lack of scheduled activities indicates a deficiency in providing varied activities to promote and improve the residents' physical, mental, and psychosocial well-being. The recreational therapist, the sole staff member in the recreation department since October 2023, reported that the absence of an activity calendar was due to a lack of materials for arts and crafts. Despite sending a requisition to the finance department in February 2024, no materials had been procured. Consequently, the recreational program was limited to individual activities such as lectures, music listening, television watching, and puzzles, with no group activities or weekend and holiday events. The therapist also mentioned the challenge of coordinating activities alone and the dependency on nursing staff to assist with recreational activities.
Failure to Develop Required Facility Assessment
Penalty
Summary
The facility failed to develop a required Facility Assessment, which is necessary to determine the resources needed to care for residents competently during both day-to-day operations and emergencies. This deficiency was identified during an entrance conference on April 7, 2024, at 10:00 AM, when surveyors requested the facility assessment. By 2:00 PM, the Administrator, who has been in the position for 1.5 years, stated that he could not find the facility assessment and would initiate and develop it. This oversight had the potential to affect all 21 residents in the facility.
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