Inspection on 20/04/06 for 121 Watley`s End

This inspection was carried out on 20th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

121 Watley`s End 14/05/07

121 Watley`s End 26/09/05

121 Watley`s End 05/05/05

121 Watley`s End 31/01/05

121 Watley`s End 11/08/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 121 Watley`s End 121 Watley`s End Road Winterbourne South Glos BS36 1QG Lead Inspector Melanie Edwards Key Inspection 20th April 2006 09:45 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 121 Watley`s End Address 121 Watley`s End Road Winterbourne South Glos BS36 1QG 01454 250232 01454 250994 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Carol Elizabeth Close Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 14 persons aged 18 years and over with learning disability who may also have physical disability and who require nursing care Staffing Notice dated 20/07/2001 applies Manager must be a RN on part 5 or 14 of the NMC register Date of last inspection 26th September 2005 Brief Description of the Service: Aspects and Milestones Trust operate 121 Watleys End Road, which is registered to provide nursing care to 14 adults with a learning disability and a physical disability. The property is located in a quiet residential area, close to local shops and amenities. There are 14 single bedrooms of various sizes, all of which have sinks. There are parking spaces and grounds to the side and rear of the house. The fees that are charged for staying at the Home are around £1000 a week. There are extra charges for chiropodist, hairdresser and the shared use and petrol costs of the minibus. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Please note due to their disabilities residents are unable to express their views verbally. Because of this time was spent talking to staff on duty about their roles and responsibilities and observing how they help and assist residents. Two registered nurses, and three care staff were interviewed about their roles and responsibilities, their training needs, and how they assist and support residents. The visiting specialist registrar was also consulted as part of the inspection. A sample of records relating to the day-to-day running and management of the Home were inspected. A selection of resident’s care records and care plans were also inspected. The Home was operating within the required conditions of registration .The conditions are set down by the Commission for Social Care Inspection and are conditions of registration which state the type of care to be provided, the needs of residents, as well as the numbers of staff who must be on duty at any time. These judgments have been made using available evidence including a visit to the service. What the service does well: What has improved since the last inspection? What they could do better: Residents would benefit if all care plans and assessments are formally reviewed and updated on a more regular basis, to demonstrate residents’ changing care needs are regularly being assessed and the care that they need reviewed. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good as residents’ assessed needs are met, and are generally being formally monitored and reviewed. EVIDENCE: To find out how residents’ care needs are assessed and how the care they need is being planned, two residents assessment records were looked at in detail. The assessments included a range of information, and detailed each resident’s range of complex care needs. One of the resident’s assessment records that were looked at had been reviewed in the last six months by a registered nurse. However the second resident’s assessment records of their needs had not been formally reviewed or updated for over eight months, meaning there is no evidence to demonstrate staff monitor residents’ changing needs. Staff on duty clearly possess a good understanding and knowledge about the complex needs of residents. Staff try to understand residents’ body language, gestures, and long-term knowledge of the resident to try and understand their needs. Staff were observed assisting residents and responding to residents body language and facial gestures. Staff communicated with residents in a warm manner, and used humour, and sensitive touch. In discussion with all the staff it was evident how fond and close staff are with residents. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate; this judgment has been made using available evidence including a visit to the service. Residents needs are met and care plans generally help demonstrate how needs are met; however care plans are not all being regularly monitored and reviewed. Residents are also well supported to take risks as part of living an independent lifestyle. EVIDENCE: There are detailed written risk assessments in place for residents to demonstrate they are being encouraged to live an independent and fulfilling life, and take part in activities away from the Home. This was also observed during the inspection. Residents are well supported by staff to attend a range of social and therapeutic activities, (see also next section of the report). Each resident also has a timetable of a range of individualised social and therapeutic activities that they regularly attend in the local community. To find out about the way that care is being provided two residents’ care plans were looked at in detail. The care plans included helpful information about the specific needs of each resident, and demonstrated how to support the residents to meet their identified needs. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 10 The care plans addressed residents’ physical, psychological, and social and sexual needs, and stated how to respond and support the person if they were upset. One of the care plans had been reviewed and updated on a regular basis, which helps to demonstrate staff are monitoring the residents care needs. The second resident’s care plan had not been reviewed on a regular basis. As has already been referred to in the report assessments and care plans are written from the perspective of `person centred planning’. This means staff help to identify what they feel residents needs are, and how best they think staff can help them. This should help ensure care is individualised and based on the needs and wishes, likes and dislikes of the residents. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. Residents are provided with a varied well balanced diet, and are supported and encouraged to live a fulfilling life. Residents are encouraged to maintain relationships and contact both in and out of the Home, and are further supported to be a part of the community. EVIDENCE: Residents are encouraged to use community facilities wherever possible .One member of staff explained that two residents had very recently been to local barbers for a haircut. Residents, who wish to, are supported to go to local churches on a regular basis. There are two different churches in the area where some of the residents attend services. It was also reported that visitors from the church come to the Home to see residents. Staff talked in detail about the importance of spending time with residents trying to encourage them to make choices in their daily lives. One good example of this was observed when one resident was being encouraged to choose their preferred breakfast meal choice. Staff also said they talk to residents when they are assisting them with their personal care and try to 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 12 encourage some residents to choose by gestures what clothes they would like to wear. Residents are supported by staff to go out for coffee, as well as to nearby pubs, and other social venues thereby helping to ensure a varied and fulfilling life. Residents access a range of community activities such as the shops, or the pub or local day care services. A small group of residents went out with day care staff during the inspection for a drive into the community. Another small group of residents went to a nearby hydrotherapy pool for a relaxation session. There are also weekend activities that some residents attend including a drop in social activity that is run by Aspects and Milestones Trust .It was reported by staff that residents who attend this regular event meet up with friends that they used to live with before moving to the Home. In the afternoon staff and residents took part in a karaoke session. Residents looked relaxed and happy during this social activity. Providing residents with such a range of opportunities help ensure residents can live normal lives and take part in community activities. The lunchtime meal was seen being served; the meal consisted of a choice of quiche lorraine with cooked vegetables and chips or an alternative, demonstrating residents are offered a choice of meals. Some meals require being puréed, and these were being presented attractively. Staff assisted residents with their food in a sensitive manner helping to ensure the meal was a relaxed and dignified experience. The kitchen area was checked thoroughly to see if food is stored and prepared in a safe environment. The kitchen was clean, tidy, and well organised. Food that requires being covered and dated in the fridge was being stored and labelled correctly. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good this judgment has been made using available evidence including a visit to the service. Residents are supported to meet their needs in the way they prefer. Also residents’ physical and emotional needs are met and their medication is handled and administered safely. EVIDENCE: Residents were observed having their needs attended to by staff who were sensitive and patient when they were assisting them. Residents were also observed rising during the morning at their preferred time. Residents’ care plans include helpful information about the preferred ways residents like to be assisted with their physical and emotional needs. The registered nurse on duty explained that residents who require dental treatment attend the dental hospital in Bristol for specialist support with their dental needs. One resident had an appointment booked for dental treatment for the following week. The specialist registrar who was visiting the Home to review resident’s medication needs, spoke positively about the quality of care and the communication from staff about residents’ changing health needs. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 14 A new service is being offered from the local GP services, the GP is going to come to the Home on a regular basis to get to know residents, and keep up to date with their changing health care needs. This is further evidence that residents’ health care needs are being closely monitored and attended to by the Home. The procedures for the administration, storage and disposal of medication were reviewed to check if there are safe systems in place for the handling administration and storage of medication. The medication administration charts of three residents were looked at detail. There was a photograph of the resident kept with their record, to ensure medication is dispensed to the correct person. The medication administration charts were legible, up to date, and contained the signature of the dispensing registered nurse, demonstrating resident’s medication is administered safely, the reasons for any omissions had also been written on the charts. Up to date records were also kept of medication being received into the Home, and medication sent back to the pharmacy, showing there are safe systems in place to monitor how much medication is held. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good as residents are protected from the risk of abuse or harm, and the complaints procedure for representatives of residents to complain is being followed correctly by management. EVIDENCE: A copy of the complaints procedure for residents’ representatives to make a complaint is on display in the hallway. This is a well-frequented part of the Home. The procedure includes contact details for the Trust and the area office of the Commission for Social Care Inspection, if someone is not happy with the outcome of a complaint investigated by the Home. There had been no new complaints recorded since before the last inspection, the record did not include the details of how the complaint was to be dealt with, or any written correspondence from the home to the person making a complaint, to demonstrate what actions were to be taken to investigate the allegation. There are policies and procedures in place relating to the issue of protection of vulnerable adults from abuse. Staff are provided with training to keep up to date in their understanding of the principle of the protection of vulnerable adults from abuse. Staff were able to explain what actions they would take in the event of them witnessing a resident at risk of harm or abuse. Staff demonstrated they understand the necessary actions they must take to ensure residents are protected. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good, as residents live in a Home that is safe and suitable for their needs and is satisfactorily clean. EVIDENCE: 121 Watleys End Road is close to local shops and residents can easily access local amenities. It is a ‘purpose built’ bungalow style property in a quiet residential area. The entrance of the building provides very easy access for wheelchair users and there is similar access to all areas. To assist residents who have disabilities there are grab rails positioned along the corridors and manual handling lifting aids in bathrooms and toilets. There are toilet and bathrooms located near to living rooms. There are specialist-adapted baths in each bathroom, as well as lifting aids. There are also walk in assisted shower rooms that residents with wheelchairs could use. All facilities were spacious in size, providing easy wheelchair access, and were clean and tidy when viewed. The bathrooms are spacious in size to provide easy access and the baths are specially adapted to assist residents. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 17 The standard of the decoration and the quality of fixtures and fittings is satisfactory. Since the last inspection three new pine wood dressers have been purchased for the main lounge, as well as two good-sized pines framed mirrors. This additional furniture helps make the environment look more homely. Bedrooms had been furnished and decorated to reflect resident’s different interests. There were visual stimulation aids as well as relaxation aids such as wall lights and mobiles seen in many rooms to provide additional stimulation and relaxation for residents. Bedrooms were decorated in different colours and this helped to create an individual feel to rooms. The environment was clean, tidy and satisfactorily maintained in communal areas and bedrooms were satisfactorily clean .The full time domestic assistant was observed cleaning the Home during the inspection. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35 Quality in this outcome area is good, as residents are supported to meet their care needs by competent staff that are being provided with regular support supervision in their work practise. EVIDENCE: The staff duty record for shifts in April 2006 was looked at to check the number of staff on duty to support residents to meet their needs. Since the last inspection three new members of staff have been recruited and this has lead to an improvement in the consistency of care for residents care and also for overall staff morale. There is a minimum of seven staff on duty for a morning shift, consisting of six care staff and one registered nurse, and five staff on an afternoon shift consisting of one registered nurse and four care staff, At night there are three staff who work a waking night consisting of one registered nurse and three care staff. The number of staff on duty for each shift met the minimum staffing numbers required by the Health Authority staffing notice under previous care homes legislation. There has been some short-term staff sickness over the last six months and as such the Home is using some bank’ staff and agency staff. Wherever possible regular bank and agency staff are required to work in the Home to ensure residents receive a consistent level of care. Staff demonstrated that they communicate and support residents in a sensitive manner, and work together well as a team. It was also reported by staff that 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 19 the team morale was high and staff felt there was good communication among themselves. Resident’s benefit as a result, as a team, which is working in this way should ensure the standard of residents care remains high. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good, as there are systems in place to maintain the health and safety of resident’s staff and visitors, and the Home is being run satisfactorily. EVIDENCE: Ms Close has been registered as manager of the Home since 2005. She is a first level registered nurse who previously worked as a deputy manager in the Home. Her work record demonstrates that she has experience of working in senior positions in Care Home settings. Ms Close has also demonstrated on previous inspections that she has developed a good understanding of her roles and responsibilities. Confidential records are kept in the office and this room is kept locked when not in use ensuring residents confidential information is held securely. Generally records were satisfactorily maintained and in order. Other records have been referenced elsewhere in this report, demonstrating well organised management in the Home. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 21 Resident’s care in the Home is being monitored externally as the monthly monitoring visits of the Home by a representative of Aspects and Milestones Trust are being undertaken as is required by law. There were detailed and informative records of these visits, and copies are sent to the Commission for Social Care Inspection each month. The records demonstrated that the designated individual responsible for the visits spends time consulting with staff and observing residents being assisted by staff. The environment looked satisfactorily maintained throughout. The fire logbook record was checked and showed the required fire tests and checks were being carried out and were kept up to date. A maintenance worker is employed by the Trust, and they will carry out routine repairs on the building. This helps demonstrate the health and safety of residents’ staff and visitors is being maintained. There are health and safety procedures in place for staff to follow to promote health and safety in the Home. All staff attends regular health and safety training provided by Aspects and Milestones trust to better help them protect residents. 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15.2(b) Requirement The care plan identifed at the inspection must be reviewed and updated. Timescale for action 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 121 Watley`s End DS0000020258.V290546.R01.S.doc Version 5.1 Page 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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