Inspection on 09/06/09 for Abbeywell Court Mental Nursing Home

This is the latest available inspection report for this service, carried out on 9th June 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Abbeywell Court Mental Nursing... 08/11/06

Abbeywell Court Mental Nursing... 18/01/06

Abbeywell Court Mental Nursing... 25/08/05

Abbeywell Court Mental Nursing... 02/02/05

Abbeywell Court Mental Nursing... 02/11/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Key inspection report Care homes for older people Name: Address: Abbeywell Court Mental Nursing Home Dragon Square Chesterton Newcastle Staffordshire ST5 7HL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joy Hoelzel     Date: 0 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Abbeywell Court Mental Nursing Home Dragon Square Chesterton Newcastle Staffordshire ST5 7HL 01782561769 01782563102 abbeywellcourt@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Abbeywell Care Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Age: Dementia (DE) age 50 years and above. Mental disorder, excluding learning disability or dementia (MD) age 50 years and above. The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 30, Mental disorder, excluding learning disability or dementia (MD) 30 Date of last inspection Brief description of the care home Abbeywell Court provides nursing care for up to thirty older people with dementia care needs and mental health problems. The home is a two-storey purpose built building situated within Chesterton village, Newcastle-under-Lyme. The home has twenty eight pleasantly furnished and decorated bedrooms between the two floors consisting of Care Homes for Older People Page 4 of 25 Over 65 0 0 30 30 Brief description of the care home twenty six single and two shared rooms. All of the bedrooms have en-suite facilities consisting of a toilet and washbasin. There is a lounge, dining room, small kitchenette and appropriately adapted toilet and bathing facilities to each floor. The central kitchen and laundry is situated on the ground floor. A passenger lift provides access between floors. Externally there is a car park and enclosed gardens. Local shops and facilities are close by and the home is within walking distance of bus routes. The fees charged by the home range from £535:00. The reader may wish to obtain more information directly from the service. Extra charges are made for hairdressing, newspapers, toiletries and clothes. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was conducted on 16th July 2007 with an annual service review 1st July 2008. On this occasion the home did not know that we would be visiting to conduct a full inspection of the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. An Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion prior to the annual service review being completed. The AQAA is a selfCare Homes for Older People Page 6 of 25 assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us the areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it the commission. Comments from the AQAA were included in this report. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information on the home is provided in two documents, the statement of purpose, which sets out what the service offers and the residents guide which offers more information when a person decides to move in. Both documents are available directly from the home. The weekly fees are not included in the residents guide, the manager explained that due the complexity of the service, the fees are arranged for each individual care package but range from £535:00 per week. The AQAA completed by the manager indicates that the information documents will be reviewed following the completion of the planned extension to the property. We looked at the case file of the person who recently moved into the home to see if information had been sought regarding this persons needs prior to moving in. Care Homes for Older People Page 10 of 25 Evidence: Information had been obtained from the previous health care setting and the manager of the service had visited this person prior to offering accommodation at the home. We looked at other case files and they included pre admission assessments by the home in addition to social worker reviews, community care services and other social care settings. The AQAA offered information on the admission process; this was confirmed by the manager explaining the robust pre admission procedures that are in place. This gathering of information ensures that the service can be confident of meeting a persons care needs. Two visitors at the home told us that they both had to make the decision for their significant other to move into the home, they stated that they were very satisfied with the accommodation and care provided. The home does not provide an intermediate care service. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The plan is person centred and focuses on the individuals strengths and personal preferences. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff respect privacy and dignity and are sensitive to changing need Evidence: Each person has a written plan of their care that is based on the assessments of their care needs. Three plans were selected to be looked at in depth with other plans looked at briefly to follow up any observations made during the day. There was no evidence in the plan that the person or their representative was included or indeed involved in the planning process. It is acknowledged that some people may be unable or do not wish to be involved but people should be offered the opportunity to comment. A visitor told us they are very happy with the care their relative receives, although they have not seen any formal care plan they are always kept updated with his health and personal care needs. They consider his needs are met at the home. Each plan contained assessments for maintaining a persons safety and when a risk is identified it is linked with a corresponding plan of care. Care Homes for Older People Page 12 of 25 Evidence: One person requires regular interventions from the nursing staff for a specific condition. Records were seen for the monitoring of this and included the frequency of the interventions and any changes that are noted. The plan documented the visits and guidance made from other health care professionals when the home requested assistance and support. Another person regularly experiences periods of anxiety and distress due to a specific condition. The care plan offered guidance to the triggers of this upset and the actions needed by staff to reduce the distress and to help this person. Each care plan included the end of life details and the action needed in the case of a medical emergency. The manager explained the multi agency approach to assist with decision making when the person lacks the capacity to make decisions for themselves. It is important that the decision is reviewed every six months using the disciplinary approach and that the mental capacity of the person is assessed on each occasion. The information is recorded, dated, signed by all parties and that a review date is noted. Some people living at the home told us that they were well cared for and that the staff looked after them very well. People who were unable to comment appeared well cared for and looked well groomed, comfortable and cosy. The staff described the diverse care needs of the people living at the home and the way they helped and assisted each person with daily life. Visitors at the home told us The care is very good, we are very satisfied with all the home offers and provides. The information recorded in the AQAA told us how they ensure that the health and personal care needs of people are addressed by using a person centred approach and focusing on the strengths of each individual. Medication is administered to people by the registered nurses, with the nurse at the time demonstrating a clear understanding of the procedures in place. We looked at the storage of the medications and a selection of the Medication Administration Records and found that arrangements are in place for ensuring a safe system is in operation. We observed staff throughout the day being very patient, understanding, caring and assisting people with care needs in a discreet and respectful way. The care records recorded the name that people preferred to be called and through out the day we heard staff addressing people accordingly. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered and supported with meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Evidence: Social and leisure activities are arranged for the people living at the home and can either be group based or on a one to one basis. At the time of the inspection there was lots of activity happening, a small group of people went to the local shop and then to the Salvation Army drop in centre for refreshments. A group of people were enjoying the relaxing effects of the mobile snoozelam that had been arranged in the lounge. One person was making small cakes for afternoon tea, whilst other people were just watching the happenings of the day. Visitors told us that they thought the activities arranged were sufficient and suitable for the dependency needs of people. The AQAA informs us thatWe provide a safe, informal ,relaxed atmosphere for our residents to live in. We welcome relatives and visitors at all times. We continue to socially include our residents into and be a part of the local community, they use the local shops, and the Care Homes for Older People Page 14 of 25 Evidence: drop-in coffee mornings at the local Salvation Army Centre, along with visits to the local pub for lunch. Snoozelam therapy is very successful in reducing anxiety and agitation levels in residents. Reminiscence therapy stimulates past memories and can trigger residents into conversation about different subjects. Many people were visiting throughout the day all appeared to be relaxed and a ease when visiting. One person stated that they welcomed the opportunity to visit at mealtimes as she was able to help her husband with his meal, this she felt was very important to both of them. The main front door is kept locked for security reasons; entry to the home is gained by staff answering the door. A number key pad is sited by the door and is used for exiting the building. Number key pads are installed by each stair well so restricting access to the ground and first floor units. Some bedroom doors were locked as were the treatment room and the store cupboards. People wishing to go outside are escorted by the staff. Meals are prepared and served by the catering staff either in the dining areas or in the persons preferred place to eat. One person told us that the meals had improved since the new chef had been appointed. People told us that the meals were good and satisfactory and that they could have snacks and drinks on request. We observed good practice when staff were assisting with lunch, demonstrating a clear understanding of people requirements and needs. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. Evidence: The information documents offer clear details of how to raise a concern or complaint about the service. The procedure is also displayed on the notice board in the home so people are aware of the action to take should they have any concerns. People told us that they would speak with the manager or deputy if they had any worries but they were satisfied with the service and that presently they had no concerns. Since the last inspection one concern was referred to the multi agency safeguarding adults group for investigation. The findings of the investigation concluded that the manager and registered nurses acted in accordance with the regulations and professional standards, and that Abbeywell Court had provided excellent care to the person. The AQAA informs us that staff have received training in the protection of vulnerable adults. Staff spoken with told us of the action they would take if they become concerned regarding the welfare of people at the home. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. All transactions are recorded on individual balance sheets with invoices and receipts kept. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is satisfactory to the specific needs of the people who live there. Evidence: Abbeywell court is a purpose built home, very close to the centre of Chesterton, with the shops and local amenities within walking distance. It is a two storey building providing accommodation for thirty people. The redecoration and replacement of the fittings and fixtures occurs as the need arises. The manager discussed the proposed plans to extend the premises with another fourteen bedrooms and additional communal space. The AQAA informs us that Our refurbishment programme has continued including some bedrooms having new furniture and redecoration. The foyer, front staircase and landing have been redecorated. Hopefully once the building work has been completed other existing areas such as corridor flooring will be renewed and areas adjacent to the extensions will be redecorated including both lounges. The front aspect of the building will have a secure sensory garden with access from the ground floor lounge extension. People living in the home told us that they are generally satisfied with the accommodation provided. They said that their bedrooms are warm, the beds comfortable and that they can have their own things with them. The bedrooms that Care Homes for Older People Page 17 of 25 Evidence: we looked at were all as individual as the occupant. During the tour of the premises all areas of the home appeared clean and hygienic. People we spoke with indicated they are satisfied with the cleanliness of their rooms and the communal areas. Suitable hand wash facilities have been provided in all areas for general hand hygiene and infection control purposes. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the staff who care for them. Evidence: People we spoke with said they were happy with the care they receive and spoke positively about the staff group.They look after me very well here, the staff are very good. Visitors told us they were satisfied with the care provided with one person commenting - The staff are very good but sometimes more carers would help. Staff told us that they get sufficient training for the job they have to do, the senior staff are very helpful and that they feel they look after the residents very well. A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. During the morning of the inspection the registered manager was on the premises supported by two registered nurses and five care staff. Domestic and catering staff were also on the premises. We observed staff working positively with the people in their care and they appeared motivated and committed to their work and demonstrated a good understanding of the individual needs of all people, including the people whose care we looked at in depth. The AQAA indicated that of the twenty seven permanent staff, eighteen have been accredited at National Vocational Qualification (NVQ), level 2 in care. With 2 staff members currently working toward NVQ level 3 in care. Staff discussed the continuing Care Homes for Older People Page 19 of 25 Evidence: opportunities for training at nvq levels. We sampled the files of three staff holding various positions within the home. All files were well presented and contained the information required to safeguard the residents living at Abbeywell Court. The manager confirmed that a Criminal Record Bureau disclosure is applied for prior to staff taking up their position within the service. We advised the manager to log the date and number of the Criminal Record Bureau disclosures of each staff member to evidence that this check has been made. Staff have their training and development needs identified through the annual appraisal of their work performance. Staff discussed the sessions and courses that have been available and included subjects such as fire safety, manual handling, Mental Capacity Act and the deprivation of liberty safeguards. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is led and managed appropriately. Evidence: Mr Hudson continues in the role of registered manager of the service, and has the experience and knowledge to run the home on a day-to-day basis. People offered positive comments on the direction and leadership of the manager, all stated that they would have no hesitation to see him if they had any concerns or worries. The AQAA contains good information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to residents. The home recognises the areas that it still needs to improve, and has clearly detailed the ways in which they are planning to do this. The service has a quality assurance and monitoring system that makes certain the home is operating as it states it does and meets its stated aims and objectives. Satisfaction surveys are sent to the relatives of the residents, with the results of the surveys considered and actioned. Staff conduct audits each month within the home to Care Homes for Older People Page 21 of 25 Evidence: ensure that systems are safe and any potential problems are identified as soon as possible. The home offers a facility for residents to deposit personal monies for safekeeping; we saw records relating to this which been maintained and fully receipted. The manager confirmed that health and safety checks for the building and the equipment are carried out regularly with the findings documented. These checks ensure that the health, safety and welfare of people living in, working in and visiting the home are promoted and protected. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. The date and number of the criminal record bureau disclosures should be recorded and available for inspection. This will then evidence that each member of staff has had the required checks to ensure they are suitable to work with vulnerable adults. 2 29 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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