Clarion Housing Association Limited (202230117)

REPORT

COMPLAINT 202230117

Clarion Housing Association Limited

27 March 2024

Our approach

The Housing Ombudsman’s approach to investigating and determining complaints is to decide what is fair in all the circumstances of the case. This is set out in the Housing Act 1996 and the Housing Ombudsman Scheme (the Scheme). The Ombudsman considers the evidence and looks to see if there has been any ‘maladministration’, for example, whether the landlord has failed to keep to the law, followed proper procedure, followed good practice, or behaved in a reasonable and competent manner.

Both the resident and the landlord have submitted information to the Ombudsman, and this has been carefully considered. Their accounts of what has happened are summarised below. This report is not an exhaustive description of all the events that have occurred in relation to this case, but an outline of the key issues as a background to the investigation’s findings.

The complaint

The complaint is about:
1. The landlord’s handling of the resident’s reports of dampness, mould and condensation.
2. The landlord’s handling of the resident’s reports of dampness and mould causing property damage, as well as affecting her wellbeing in the home.
The Service has also considered:
1. The landlord’s complaint handling.
2. The landlord’s record keeping.

Background and summary of events

Policies, Procedure and Good Practice

The landlord has a 2 stage complaints procedure. The landlord devised an interim complaints policy in June 2022 following a cyber attack. The interim policy set out the following response timescales:
1. At stage 1 the landlord should acknowledge the complaint within 10 working days and respond within 20 working days.
2. At stage 2 the landlord should acknowledge the complaint within 10 working days and complete a peer review within 40 working days.
The landlord’s Compensation Policy states with regards to discretionary compensation offers:
1. “Awards of £50 to £250 – Remedies in the range of these amounts may be used for instances of service failure resulting in some impact on the complainant.”
2. “Awards of £250 to £700 – Remedies in the range of these amounts may be for cases where you found considerable failure but there may be no permanent impact on the complainant.”
3. “Awards of £700 and above – Remedies in the range of these amounts are used in recognition of failure that has had a severe long-term impact on the complainant. Remedies in this range will be appropriate when there has been a significant and serious long-term effect on the complainant, including physical or emotional impact, or both.”
The Ombudsman’s Spotlight report of October 2021 on Damp and Mould states “Landlords should adopt a zero tolerance approach to damp and mould interventions. Landlords should review their current strategy and consider whether their approach will achieve this.”
The landlord’s self-assessment against the Ombudsman’s recommendations in the Spotlight report states:
1. “Our new approach starts with five principles; we must respond in an urgent and timely manner to any report of leaks, condensation, damp and mould (LCDM), we must fully investigate & treat the root cause of every reported LCDM case in an urgent and timely manner…we must keep complete & extensive records of each case including photographic records during each visit, we must keep the customer updated at every stage of the repairs journey and provide a single point of contact.” (Completion Date: December 2022).
2. “We will also assign resident liaison officers (RLO) to the LCDM cases, so that customers have regular proactive contact from us. We will also assign a named surveyor to act as a case owner for each LCDM case.” (Completion Date: December 2022).
The landlord’s Leak, Condensation, Damp and Mould (LCDM) policy (February 2023) states: “We will carry out any repairs that are required in accordance with our Repairs and Maintenance Policy, which includes timescales and escalation routes. Cases relating to leaks condensation, damp and mould will be specifically tracked and managed.”
The landlord’s Repairs and Maintenance Policy states that “non-emergency repairs are appointed by the contact centre at the initial point of contact. These appointments are termed as ‘at residents’ convenience’ offering the next available appointment that suits the resident and will be offered within 28 calendar days of the repair being reported.”

Summary of Events

The resident is an assured tenant of the landlord, her tenancy commencing on 7 June 2022. The property is a one-bedroom ground-floor flat. The landlord has noted that the resident has combined ADHD, learning difficulties, Multiple Sclerosis, Osteoarthritis, Rheumatoid arthritis and is a partial wheelchair user due to Ehlers-Danlos syndrome. The resident’s rent at the time her tenancy began was £435.33 monthly. From April 2023, the rent increased to £482.22.
On 16 January 2023 the resident complained about damp and mould in her property, attaching photos. She stated that:
1. She moved into the property in June 2022, and it was clear the previous mould had been painted over.
2. She did not hang washing to dry in her home. She opened her windows to circulate air and heated her home correctly. She also opened windows when she was cooking and showering, and her furniture had a gap between the walls to keep them ventilated.
3. There was visible rising damp and severe damp patches on the brick work outside of the building which she believed was present prior to her moving in.
4. She had constant condensation and black mould in her property. These issues had affected her health with one hospital stay and 6 course of anti-biotics.
The landlord arranged an appointment for 1 February 2023 which the resident rearranged for 20 February 2023.
The resident wrote further on 24 January 2023 stating that there was mould in another room with water visibly seeping near a plug socket. There was damage to furniture and her carpet which required replacing.
On 25 January 2023 the landlord registered a complaint and stated it would respond within the next 10 working days.
An internal email dated 13 February 2023 noted that an “inspection was carried out yesterday on the gable end wall using a thermal imaging camera. No defects were identified with the wall, which was found to be dry with no water found in the cavity at damp course level.”
On 16 February 2023 the landlord sent the stage 1 response:
1. It noted an Area Manager had requested a surveyor visit and that its LCDM team would be attending the resident’s property on 20 February 2023 to investigate the mould and carry out treatment works.
2. It accepted that there was a failing in the service of its repair contractor by not treating the damp and mould sooner even though it attended within its service level agreement. This was due to the length of time the resident had experienced damp and mould.
3. It offered compensation of £350 comprising:
  1. £300 – inconvenience suffered or a degree of disruption to the household and “resident repeatedly having to chase.”
  2. £50 – responding to the complaint outside the agreed timeframe.
On 16 February 2023 the resident escalated the complaint stating that:
1. She did not think £350 was sufficient and did not want compensation offset against her arrears.
2. She wanted £400 to replace damaged furniture and for fuel for GP and hospital visits.
3. She wanted the landlord to replace the seals on the windows and install more powerful extractor fans.
4. She had spent £950 on carpet in the lounge and wanted it replaced with vinyl flooring.
On 17 February 2023 the landlord confirmed it had registered a stage 2 complaint.
On 20 February 2023 the landlord’s LCDM team’s contractor attended the resident’s property. There is no contemporaneous record of the visit and, as such, the landlord’s repair records do not confirm what works were carried out. The landlord’s stage 2 response advised that an operative found “minor” mould and treated it but failed to complete a full LCDM Report, including photos so it was unable to confirm their assessment, works or otherwise. The operative requested a surveyor visit to assess the underlying issues.
On 20 February 2023 the resident advised the landlord that “Today 3 months after my initial report I saw a lovely surveyor who confirmed the issues with my property were due to structural issues as well as ventilation blocks being covered (plastered over) this obviously was done before I moved in.” She advised that her carpet was saturated due to a leak and that she had another respiratory infection. She again requested the replacement of her flooring and £400 for furniture.
Om 4 March 2023 the landlord confirmed it would carry out a peer review of the resident’s complaint after she escalated it on 16 February 2023 and that it aimed to respond within 20 working days. Following the complaint escalation, the landlord noted that it had not arranged a surveyor visit and arranged one for 16 March 2023. This was rescheduled for 29 March 2023 at the resident’s request.
On 24 March 2023 the landlord sent the stage 2 response to the complaint:
1. The operative who attended on 20 February 2023 did not note any damage to the carpet. However, there was a failing in its service as the operative did not complete a LCDM report.
2. A surveyor would now attend on 29 March 2023. The surveyor would assess any damage to the carpet, and make recommendations and order works as necessary.
3. It accepted that an RLO from the LCDM team had failed to schedule a surveyor visit following the request from the operative on 20 February 2023.
4. It awarded compensation of £200 comprising:
  1. £150 for the delay in the inspection by the surveyor.
  2. £50 for the complaint being resolved outside published timeframes.
The landlord’s surveyor inspected the resident’s property on 29 March 2023. According to an internal email sent on 19 January 2024, at this inspection it noted that mould had recently been treated by the resident and that she had renewed her carpets therefore there was no mould growth visible. The surveyor took photos although there is no evidence that photos of flooring was taken, or a report was completed. The resident has advised the Service that she has only replaced the hallway carpet with vinyl flooring but has not changed the lounge carpet which remains damp.
On the same day and in further emails sent on 2 and 3 May 2023 the resident responded advising that she was unhappy with the stage 2 response. She wanted the landlord to:
1. Fix structural issues. Adding that the surveyor at the inspection of 29 March 2023 had confirmed that breeze blocks had been plastered over.
2. Replace the window as the panes had blown making her house cold.
3. Treat the mould. The surveyor had advised that he would order this.
4. Replace flooring and her furniture.
On 19 June 2023 the resident reported damaged panes and seals to her windows which in bad weather let water into her property, and that her bathroom window in particular was cracked. She noted that the landlord was “fully aware” of her illness and that she was “highly vulnerable” due to her multiple health conditions, and that she was in and out of hospital receiving treatment. The landlord advised a surveyor should contact her within a week and that its repairs team would attend her property on 13 July 2023.
On 16 July 2023 and 1 August 2023, the resident emailed the landlord advising that it still had not carried out works to repair structural issues or wipe mould away following the initial survey, which had cost her £4,000 in furniture and flooring.
According to a surveyor report dated 12 October 2023, the landlord noted the skirting in the lounge was damp, and that the external gable end wall was damp with mould growth at the bottom, therefore there was a potential problem with brickwork and the damp course. It suggested the removal of bricks to inspect. The landlord noted the resident had replaced her carpet and underlay, sofa, unit, bookshelf and curtains.
On 14 November 2023 the resident completed another complaint form stating that repairs had neither been completed after the initial survey of March 2023 nor the survey of October 2023. She wanted compensation of £200 for cleaning mould, £2,000 for replacing the carpet and underlay in the lounge and hall, and the replacement of her furniture including her sofa. She also requested compensation for living in a property with a damaged damp course, rising damp, black mould and damaged windows.
The landlord’s repair records indicate that on 22 November 2023 it cleared metal sheets and timber stored against the side wall of the property then removed 3 airbricks to allow the surveyor to inspect the wall cavity. The landlord has not provided a contemporaneous record of the inspection. The internal email sent on 19 January 2024 noted that it found no faults or defects with damp course or on inspection of cavity, which was found to be dry. The resident has advised the Service that the landlord was meant to check the damp course but took out bricks above the ground, away from where the damp course was.
The internal email dated 19 January 2024 noted “we need to install a positive pressure unit in the flat and monitor the internal conditions via a Vericon surveyors’ cube.” (The Vericon surveyors’ cube is a branded package of products that aims to aid surveyors in identifying the root cause of damp and mould issues in a property.)
The resident has informed the Service that on 25 January 2024 the local authority’s Environmental Health Team inspected her flat.
In an exchange of correspondence from 31 January 2024, the landlord told the resident that it had not found anything with the wall to her property following the removal of bricks. It wanted to reattend her property on 9 February 2024 to discuss the installation of a “Switchee”. The resident said she was not available due to being hospitalised and wanted the landlord to await the Environmental Health report.
On 31 January 2024 Environmental Health wrote to the landlord in respect of damp and mould hazards under the Housing Health and Safety Rating System. It stated:
1. Airbricks on the north facing external wall have fallen out.
2. Hallway wall is damp by radiator and front door.
3. Bathroom extractor fan is on constantly, this is a humidity sensor one.
4. Broken window handles on bedroom and bathroom. Mould along window sealant in every room.
5. Windowpanes have blown in sitting room, bedroom and kitchen.
6. Glass panels installed above the bedroom, kitchen and living room doors need to be removed and replaced with fire-resistant material.
7. Sitting room north facing external wall is damp, carpet is also damp.
8. Extractor fan in kitchen does not work. Damp on the external walls and on the adjoining wall with the sitting room.
Environmental Health asked the landlord to respond by 14 January 2024 after which it would decide whether to take enforcement action. (It also observed fire hazards which are not pertinent to this complaint).
The resident has provided further correspondence confirming that the landlord would now install the Vericon Cube on 22 April 2024 although she disputed the need for a further inspection and wanted works to be carried out. She has also told the landlord and the Service that as the damp and mould is more evident in winter, from October to March, the findings from damp equipment will not be reflective of the situation in her property.
In an email sent on 5 March 2024, Environmental Health informed the resident that the landlord had provided it with a list of all works to be completed, including the installation of new windows. However, on 19 March 2024 the resident advised the Service that it had not booked any works yet.

Assessment and findings

Scope of the investigation

The resident’s complaint completed the landlord’s complaints procedure on 24 March 2023. The resident has provided a stage 1 complaint to a further complaint she made dated 23 February 2024. The response addressed a complaint about fire safety but confirmed that the landlord would not address a further complaint about its handling of damp and mould issues as this complaint had already completed its complaints procedure. The Service also notes that the resident reported the same damp and mould issues after the stage 2 response. Given that the issues have persisted and the landlord has declined to open a new complaint for the resident relating to damp and mould, this investigation has therefore considered the landlord’s handling of the further reports after stage 2 response of 24 March 2023.
While the Service is an alternative to the courts, it is unable to establish legal liability or whether a landlord’s actions or lack of action have had a detrimental impact on a resident’s health. Nor can it calculate or award damages. The Service is therefore unable to consider the personal injury aspects of the resident’s complaint. These matters are likely better suited to consideration by a court or via a personal injury claim against the landlord’s liability insurer.

The landlord’s handling of the resident’s reports of dampness, mould and condensation

This report does not seek to make an independent, technical assessment of the damp and mould reported by the resident in her property. In this case, the Ombudsman has assessed the reasonableness and appropriateness of the landlord’s response to matters raised, taking into account whether it reasonably applied its policy and procedure, complied with relevant legislation, and followed good practice.
In accordance with the terms of the tenancy agreement and the Landlord and Tenant Act 1985 the landlord is obliged to keep in repair the internal structure of the property, which may include issues resulting in damp and mould. It was therefore necessary for the landlord to investigate the resident’s reports of mould in her property and to take appropriate action to resolve any issues it identified which fell within its repairing obligations. The Ombudsman’s Spotlight Report on Damp and Mould (published October 2021), highlights the general need for landlords to adopt a zero-tolerance approach to damp and mould interventions, to review their strategies, and consider whether their approach will achieve this.
Following the resident’s initial report of 16 January 2023, it was appropriate that the landlord arranged an inspection. This is because inspections by appropriately qualified staff are crucial to the diagnosis of issues. However, the landlord did not complete a LCDM report or otherwise keep a record of inspection. The importance of completing a report is recognised in the landlord’s principles for dealing with damp and mould which indeed states that photographs should also be taken at each visit. Therefore, the landlord did not have an appropriately detailed record upon which it could rely to justify its findings that mould was “minor” and did not cause damage to the carpet.
The landlord’s principles of dealing with damp and mould cases recognised the importance of keeping the “customer updated”. However, it also did not manage the resident’s expectations effectively at this point. The landlord had suggested that a surveyor would be investigating the mould at the appointment of 20 February 2023. The resident’s email of 20 February 2023 indicates that she understood a surveyor had attended; however, an operative had attended. Moreover, in the email the resident advised that the ‘surveyor’ identified structural issues and blocked ventilation. This was not the landlord’s recollection of this visit, and indeed the surveyor inspection was pending. The discrepancy indicates that it had failed to manage the resident’s expectations as to what further action it would take, and in fact may have misinformed her.
The landlord’s stage 2 response confirms that it should have arranged a follow-on surveyor visit straight after the visit of 20 February 2023 but that it delayed in doing so. Although the landlord carried out a surveyor inspection on 29 March 2023, it did not complete a LCDM report even though it had accepted in the stage 2 response that this report should be on file. The report may have assisted the landlord in identifying underlying reasons for the mould growth which it had accepted was present before being cleared. The absence of the report is a further record keeping failure. Ultimately, clear record keeping and management is a core function of a repairs service, because this assists the landlord in fulfilling its repair obligations. Accurate and complete records ensure that the landlord has a good understanding of the age and condition of the structure and its fittings within the property, enable outstanding repairs to be monitored and managed, and enable the landlord to provide accurate information to residents. Staff should be aware of a landlord’s record management policy and procedures and adhere to these, as should contractors.
There is also no evidence that the landlord communicated and justified its findings from the inspection of 19 March 2023 to the resident. It is important that landlords are transparent with residents so as to help them understand the findings reached in complaints about repairs. The landlord’s failings in this regard contributed to the resident’s perception that it was unwilling to take the necessary action to resolve the issues she had reported. In fact, the landlord did not consider the particular repair issues underlying her concerns about damp and mould. The resident had raised concerns about the watertightness of her windows and the effectiveness of her extractor fans. She also stated that water was seeping near a plug socket which was potentially dangerous. She also stated that there was painting directly on breezeblocks. However, the landlord did not consider and address these issues.
The resident continued to report damp and mould in her property and repairs to the windows after the stage 2 response, between May and August 2023. The landlord in line with its repair obligations had a responsibility to investigate further and its principles for dealing with damp and mould cases says it should respond in a “timely and urgent manner”. However, there is no evidence that the landlord arranged for a surveyor to contact her. The landlord’s repair records also show that the visit by the contractor for 13 July 2023 was not completed, only “posted”. Ultimately, there is no evidence that the landlord took substantive action to address the resident’s ongoing concerns about damp and mould until the surveyor inspection of October 2023. This was an unreasonable delay.
The landlord followed the recommendations on the surveyor report of 12 October 2023 insofar as it removed bricks and checked the damp proof course. However, it has provided no good reason why it took 6 weeks for this to take place. Again, there are no contemporaneous records of the inspection or checks to the damp course which is a further failure in its record keeping. There is also no evidence that the landlord explained its findings to the resident, leaving her uncertain as to whether it had reached reliable, evidence-based findings. In fact, she has questioned that the landlord removed the correct bricks to check the damp course.
The landlord’s self-assessment states that a RLO should have been in regular contact with the resident and their duties included updating her on the outcome of visits. There is no evidence that this was consistently followed.
The landlord’s internal email of 19 January 2024 stated it wanted to monitor the internal conditions of the resident’s flat. This indicates that it held concerns about the temperature and humidity in the resident’s property, at the very least. The monitoring of the internal conditions of the resident’s priority through instruments is a positive step towards resolving her complaint; however the landlord’s repair records do not make clear why the landlord is undertaking this course of action at this time. Nor is there evidence showing good reason why this action was not pursued earlier.
In summary, the landlord did not consistently follow its principles for dealing with damp and mould cases. It delayed in sending surveyors to investigate the resident’s reports of damp and mould. When it attended it did not investigate possible underlying reasons for the presence of mould, aside from the damp proof course, or maintain repair records that were reliable and timely. The landlord has also not communicated effectively with the resident by making clear its findings. The resident’s responses in fact indicate that it may have misinformed at one point her by accepting that there were structural issues.
By way of compensation for the resident’s loss of enjoyment of her property because of damp and mould the Service has ordered £1468.91 compensation. This reflects the resident’s loss of enjoyment of her property between 29 March 2023 (when the landlord failed to complete a LCDM report) to 31 January 2024 (when Environmental Health confirmed mould within the property). This is calculated at 30% of the rent for the period which takes into account there are 4 rooms in the resident’s property (the bedroom, bathroom, lounge and kitchen, but also that the resident’s statement that the severity of the mould is not consistent but worse from October to March, and worse in the lounge.

The landlord’s handling of the resident’s reports of dampness and mould causing property damage, as well as affecting her wellbeing in the home

In her complaint of 16 January 2023 and in her subsequent correspondence, the resident stated that her furnishings had been damaged and that she had incurred extra costs. The landlord in fact stated in the stage 2 response that it would assess whether her carpet had been damaged. However, there is no evidence that the landlord reached a reliable and informed decision on the condition of the carpet throughout the property, for instance by making notes of where it inspected and taking photos. Furthermore, there is no evidence that it advised the resident of its findings on the condition of the carpet. In addition to the carpet the resident requested compensation for damage to her furniture and other costs incurred; however, the landlord also failed to consider these aspects of her claim.
Ultimately, the resident was seeking to recover the costs she stated she incurred due to the condition of her property. In the absence of accepting responsibility for these costs, the landlord should have advised the resident what her options were, especially as it noted she had felt the need to replace some items. This included advising the resident about making an insurance claim and confirming whether a claim could be made against its building insurance. Therefore, the landlord did not take the necessary action to resolve this aspect of the resident’s complaint.
The resident also reported how she thought damp and mould in her property affected her health. Taken together with her recorded vulnerabilities, there was a potential elevated detrimental impact to the resident which the landlord had a responsibility to be mindful of and address. However, the landlord did not even acknowledge the resident’s concerns about her health. In fact, it again missed an opportunity to direct the resident to make a claim.

Complaint Handling

Both the landlord’s complaint responses were outside the timeframe for responding. The stage 1 response was 6 working days outside the timeframe and that stage 2 response was. The stage 2 response was 5 working days outside the timeframe after the landlord acknowledged the escalated complaint on 17 February 2023 and confirmed a 20-day response timeframe. In both instances the landlord offered £50 compensation which was a sum in line with its Compensation Procedure and proportionate to the delay.
At the time of the stage 2 response, the landlord offered a sum total of £450 for failings in its handling of damp and mould issues, £300 for prior delays in treating the damp and £150 specifically for the delay in the surveyor’s inspection. In acknowledging these failings and awarding compensation in line with its Compensation Procedure the landlord took steps to resolving the complaint. However, it has not offered compensation to reflect that it did not investigate possible underlying reasons for the presence of mould or maintain contemporaneous repair records that reliably justified its position of the resident’s case. It has also not offered compensation for the delay in carrying out further investigations after the resident continued to report damp and mould after the stage 2 response.
An aspect of the resident’s complaint was her request for compensation for damage to her furnishings and other costs. She also outlined the impact on her health. The landlord did not address these aspects of her complaint. With these issues, it did not follow good practice as set out in the Service’s Complaint Handling Code which states that “Landlords must address all points raised in the complaint and provide clear reasons for any decisions, referencing the relevant policy, law and good practice where appropriate.” Taken altogether, while the landlord has offered compensation to the resident, its offer does not reflect the full duration and circumstances of the case. The offer therefore does not provide reasonable redress for the overall detriment experienced by the resident arising from the landlord’s failings.

Determination (decision)

In accordance with paragraph 52 of the Housing Ombudsman Scheme, there was maladministration by the landlord in respect of its handling of the resident’s reports of dampness, mould and condensation.
In accordance with paragraph 52 of the Housing Ombudsman Scheme, there was maladministration by the landlord in respect of its handling of the resident’s reports of dampness and mould causing property damage, as well as affecting her wellbeing in the home.
In accordance with paragraph 52 of the Housing Ombudsman Scheme, there was service failure by the landlord in respect of its complaint handling.
In accordance with paragraph 52 of the Housing Ombudsman Scheme, there was maladministration by the landlord in respect of its record keeping.

Reasons

The landlord has delayed in investigating the resident’s reports of damp and mould. It has not adequately investigated all possible underlying reasons for the presence of mould or maintained repair records that were reliable and timely. The landlord has also not communicated effectively with the resident by making clear its findings.
There is no evidence that the landlord reached a fully reliable and informed decision on the condition of the carpet. The landlord did not respond to or advise the resident of her options regarding her claim for other costs she stated she incurred due to the condition of her property. It also did not direct the resident to make a claim after she reported the impact on her health from the condition of her property.
The landlord did not address all aspects of the resident’s complaint and its compensation offer does not reflect the full duration and circumstances of the case.

Orders

The landlord is ordered, within the next 4 weeks, to:
1. Send a written apology to the resident for the failures identified in this report.
2. Pay the resident compensation of £2,218.92 comprising:
  1. £300 for the distress and inconvenience caused by the failings in its investigations into her reports of damp and mould, its record keeping and not making clear its findings.
  2. £1,468.92 to reflect the resident’s loss of enjoyment of her property between 29 March 2023 and 31 January 2024 due to damp and mould.
  3. £300 for the distress and inconvenience caused by its failure to adequately consider the resident’s claim for damages to her property and other costs arising from dampness and mould causing, as well as her reports on how her health and wellbeing had been affected.
  4. £150 for the distress and inconvenience caused by the failings in its complaint handling.
3. Confirm to the resident what works it will be carrying out to remedy dampness and mould in light of the recent report by Environmental Health, and complete them.
4. Confirm and explain its position on the resident’s claim for damages to her property and other costs arising from dampness and mould, and her reports on how her health and wellbeing had been affected. If the matter is to be considered by its insurers and/or it requires further information it should make this clear.
5. Write to the Housing Ombudsman Service to set out what measures it has in place to ensure that:
  1. The principles for dealing with damp and mould as set out in the self-assessment against the Spotlight Report on Damp and Mould are followed.
  2. RLO’s and surveyors are allocated to LCDM cases and updates are provided to residents.
  3. Complete and contemporaneous records, including photographs, are kept after each visit.