Inspection on 25/05/06 for Dallimore House

This inspection was carried out on 25th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dallimore House 29/08/08

Dallimore House 01/08/07

Dallimore House 15/11/05

Dallimore House 17/05/05

Dallimore House 21/01/05

Dallimore House 12/08/04

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Insight - Eastchurch

Southfields

Thorndene

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Guildford Road (2a) 2a Guildford Road Chertsey Surrey KT16 0QA Lead Inspector Vera Bulbeck Unannounced Inspection 23rd May 2006 10:00 Guildford Road (2a) DS0000013481.V294740.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 Guildford Road (2a) DS0000013481.V294740.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. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Guildford Road (2a) Address 2a Guildford Road Chertsey Surrey KT16 0QA 01932 568553 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) Welmede Housing Association Ltd Mr Atmaran Beedasee Care Home 12 Category(ies) of Learning disability (12), Physical disability (4) registration, with number of places Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. It is a condition of Registration that of the twelve people accommodated in the home, up to four may be PD 15th November 2005 Date of last inspection Brief Description of the Service: 2a Guildford Road is a detached property situated off of the main road and within walking distance of Chertsey town centre. The home is owned and managed by Welmede Housing Association, with the staff team employed by North East Surrey Primary Care Trust. The home provides accommodation and care for up to twelve people who have a learning disability, four of whom may also have a physical disability. The accommodation has communal facilities on each floor so that service users are able to live in smaller groups. There are currently six service users living on the first floor and four on the ground floor. The ground floor is wheelchair accessible throughout and has an assisted bath. Each floor has its own lounge, dining room, kitchen, laundry and toilet and bathing facilities. All bedrooms are single occupancy and none are en-suite. The first floor can be reached by two sets of stairs; there is no passenger lift or stair lift. There is a well-equipped sensory room on the first floor. The home has the use of two vehicles to access activities and local amenities and has limited parking to the side of the building. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced site visit to be undertaken by the Commission for Social Care Inspection year April 2006 to March 2007. Mrs Vera Bulbeck Regulation Inspector carried out the inspection. Mr Edward (Ed) Clawson shift leader for the home was present. The inspection was undertaken over 6 hours and 30 minutes. There are currently ten residents living in the home, and the majority have lived in the home for some considerable time. All the residents were at home on the day of the visit except one who had gone on holiday with his parents. The inspector was able to speak with some of the residents. A number of staff was spoken to and one commented the home is operating on an open management style and the new staff team feel supported and work together as a stable team. A full tour of the premises was undertaken. Three care plans were inspected. The inspector would like to thank the residents and staff members for their time, assistance and hospitality during the inspection. The residents living in the home wish to be called residents, therefore service users will be referred to as residents throughout the report. An improvement plan must be submitted to the Commission for Social Care Inspection (CSCI) with dates and timescales regarding the requirements made at the site visit on 25/05/06. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 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. Guildford Road (2a) DS0000013481.V294740.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 Guildford Road (2a) DS0000013481.V294740.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 adequate. This judgement has been made using available evidence including a visit to this service. The home would greatly benefit with more management input spending more time in the service particularly undertaking management duties. EVIDENCE: A manager from another Welmede service is currently managing the home. On the day of the visit the person in charge of the home had already received news that a member of staff was sick and would not be available for duty. There are mainly all new staff working in the home and the majority are not familiar with the records or where the records are held. The pre assessment records were not available. Guildford Road (2a) DS0000013481.V294740.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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ individual plans need to be reorganised and to be clear and comprehensive including details of needs and goals. They also need to incorporate known or indicated preferences and choices, and include risk assessments. EVIDENCE: The inspector was not able to communicate with the majority of the residents and observation of the practices was observed. It was noted that staff that have not had figure four-arm restraint training are not able to work on the first floor without a person qualified. This method of restraint is only currently used on one resident and the records indicate that the other residents get extremely worried by the activity. The records also indicated that the residents are scared of one particular resident. The last incident recorded stated that residents were scared, shaken and distressed. The care plans are in need of updating and information held on file is old. For example one resident’s last review dated 03/10/05 states there should be 2 –1 staff for this particular resident. It was noted that nearly every week the Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 10 resident goes home to his family and no incidents occur. It would appear from the records that he gets bored in a confined space and incidents happen. The inspector advised the member of staff to contact the care management team for another review to ensure the resident is in a placement suitable to his needs. Risk assessments were in need of updating and some had not been signed or dated. Guildford Road (2a) DS0000013481.V294740.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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s rights and responsibilities are recognised. EVIDENCE: Staff stated that they actively encourage and support residents to be independent, to make their own choices and to live their lives as they wish, as far as they are able. Staff stated they are aware of the resident’s likes and dislikes and two residents understand Makaton. The inspector was informed that none of the residents have a job and no one is in involved in adult education. The home has the use of a vehicle, however; this is difficult as the staffing levels are not sufficient at all times to be able to take residents out. Household routines are kept to a minimum and are only in place to enable residents to share their home’s facilities and to maintain harmony within the household. The degree to which residents are involved in the running of their home needs to be described in the statement of purpose. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 12 It was observed, that staff knock before entering resident’s bedrooms and that personal care is offered discreetly. Residents are addressed in the way that they prefer and this needs to be recorded in their individual plan. Staff arranges the menu taking into consideration residents likes and dislikes, a dietician is involved and one resident has a list of food he is able to eat. The main meal is at lunchtime and in the evenings a lighter cooked meal is served. The majority of residents have contact with family and friends and some residents have an advocate. Guildford Road (2a) DS0000013481.V294740.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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. However, there were some discrepancies with regards to the administration of medication. Up dates to staff training on the administration of medication needs to be undertaken. EVIDENCE: From the individual plans and speaking to staff, it was evident that a number of healthcare professionals are involved in the support of the residents. These include general practitioners (G.P.), chiropodists, opticians, dentists and hospital specialists. The person in charge stated that the administration of medication is carried out by nominated, “key holder”, members of staff. These members of staff are detailed on a daily handover sheet, which specifies the staffing arrangements for each shift. There are no residents living in the home who are able to self medicate. It was noted that generally medication administration was undertaken in a professional manner. However, a new book is required for the medication Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 14 returned to the pharmacy and medication received into the home. The list of staff signatures needs to be updated with the new staff included. All staff that administers rectal diazepam and injections for a diabetic resident needs to have appropriate training by the community nurse and a record of staff trained must be available for inspection. The inspector advised the staff member in charge to contact the G.P with regards to a resident who takes his crushed medication with jam, to discuss and have appropriate records on the residents care plan of the procedure advised by the doctor. Guildford Road (2a) DS0000013481.V294740.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 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All required policies, procedures and practices are in place to ensure that residents are safeguarded, as far as reasonably possible, from harm or abuse, and to ensure that residents feel their views will be listened to. EVIDENCE: The records indicated the home has not received any recorded complaints since the previous inspection. The shift leader in charge on the day of inspection was not aware of the procedure for handling a complaint and stated he would pass any complaints onto the management to deal with. The complaints policy and procedure needs to be updated and the inspector would advise residents are provided with a copy in picture form, and a copy should be provided to relatives. Further to speaking with the staff, it was clear they had received training in the protection of vulnerable adults and whistle blowing procedure. The shift leader in charge had been working in the home for some time, however the majority of staff on duty were new and have been working in the home for a short period of time. Staff commented they are aware of their responsibility to report any concerns they have and stated that they would report any concerns to the manager. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 16 Records indicated that at times residents feel frightened and need to be removed from their lounge to their bedroom when an incident takes place. A review needs to be undertaken of the resident’s who at times create the scene, management to ensure all the residents living in the home feel safe and secure. The inspector was informed the manager of the home controls the resident’s finances and records were seen indicating balances were correct. All residents have a bank account. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 17 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The location and layout of the home is suitable for it’s stated purpose. It is accessible, safe and reasonably well maintained. The home was found to meet residents’ individual and collective needs in a comfortable and homely way. EVIDENCE: The home is homely and residents observed to enjoy living in the home. However, there are several areas around the home that require attention; these include the upstairs hallway wall and a resident’s bedroom wall needs attention. Several bedrooms were in need of decorating and a light on the landing needed a shade. There are two iron burn marks on the carpet on the upstairs landing, this needs to be attended to either a new carpet or replacing the areas which is currently burnt. It was also noted that a toilet needs a new bin with a lid. The staff to be congratulated on the cleanliness of the premises, which, were found to be clean and hygienic apart from the kitchens, which needs a complete clean. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 18 Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 19 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, 33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Evidence was not available to demonstrate that staff have been trained to do their jobs. The staff recruitment records were not available. EVIDENCE: On the day of the visit the manager who is currently managing two care services was on holiday. The staff member in charge of the home did not have access to staff files, therefore it was not possible inspect the staff records. It was not known if all staff had received a criminal record bureau (CRB) check, or a POVA check. The management needs to produce a training plan to enable management of the home to see staff requiring training and updates to training. There is currently no staff with NVQ qualifications. However, there are two staff in the process of completing NVQ Level 3, and two staff undertaking NVQ Level 2. And another two staff members, currently undertaking NVQ Level 4 in management. On the day of the visit the training plan was not available. There should be five care staff on duty on the first floor and four staff on duty on the ground floor. According to the rota on a number of occasions the Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 20 staffing levels are lower than required. The manager needs to be included on the rota with the days and hours working in the home. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 21 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, 40 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s would benefit from the manager to spend more time in the home to enable the residents and staff an open, positive and inclusive atmosphere. The systems for resident’s consultation need to be reviewed to enable the residents to make their views known. EVIDENCE: As a matter of priority the home needs to implement a Fire Risk assessment to include all rooms and communal areas of the home, as well as introducing an emergency contingency plan in the event of a major incident. All bedroom doors should be numbered and a copy should be held next to the fire alarm system. All fire records should be held in one folder in the event of an emergency all records would be available for the fire officer. The kitchens were in need of a professional clean, the ceiling and the floor underneath and beside the fridge and cooker were very dirty. The extractor Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 22 fan was also very dirty and needs cleaning. The staffing levels are not adequate to include deep cleaning as required under the health and safety legislation. It was also noted in the laundry that cleaning materials were found and a large container of pine disinfectant. Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 23 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 2 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 2 35 3 36 2 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 2 X X X 2 2 X 2 X Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 24 Yes 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 YA42 Regulation 13 Requirement The registered person must ensure that all risk assessments carried out by the home are reviewed regularly as necessary (at least annually) in order to be sure that appropriate preventative measures remain in place. (Timescale of 15/12/05 not met). Care Plans to be updated and reorganised. To review progress of last review November 2005 of a resident discussed at inspection. A new book required for medication to be returned to the pharmacist and received in the home. Staff signatures need to be updated for administering medication. To produce training records for staff administering rectal diazepam and diabetic injections. Management to discuss with G.P the administration of tablets given in Jam, and records to be held on the care plan. Complaints procedure refers to NCSC January 2002 needs DS0000013481.V294740.R01.S.doc Timescale for action 30/06/06 2 3 4 YA6 YA7 YA20 12 12 17 30/06/06 30/06/06 02/06/06 5 6 7 YA20 YA20 YA20 17 17 13 02/06/06 23/06/06 23/06/06 8 YA22 17 30/06/06 Guildford Road (2a) Version 5.1 Page 25 updating. 9 YA24 23 Management to produce a redecorating plan for resident’s bedrooms with dates and timescales. The walls in the upstairs hallway and a resident’s bedroom need attention. The hallway carpet upstairs with iron burn marks on needs replacing. The landing light needs a shade. To replace a bin in the upstairs toilet. Staffing levels must be maintained at all times. Staffing levels must be reviewed upstairs during the day and night. All staff must receive a copy of the General Social Council and Care document, code of practice. A training plan to be implemented. Staff training to be undertaken and updates to training required. All staff requires regular supervision. Staff meetings to be implemented. The manager to spend more time in the home undertaking management duties. All policies and procedures need updating. The kitchens must have a routine cleaning programme and needs to be professionally cleaned. To provide a hoist for residents who need moving and handling. Management to produce a fire risk assessment on the whole house. Management to produce an emergency contingency plan. All bedroom should be numbered DS0000013481.V294740.R01.S.doc 30/06/06 10 11 12 13 14 15 16 17 18 19 20 21 22 23 YA24 YA24 YA24 YA24 YA33 YA33 YA34 YA35 YA35 YA36 YA39 YA39 YA40 YA42 23 23 23 16 18 18 17 24 24 18 24 24 17 16 14/07/06 28/07/06 23/06/06 09/06/06 25/05/06 09/06/06 30/06/06 30/06/06 28/07/06 28/07/06 30/06/06 02/06/06 28/07/06 16/06/06 24 25 26 27 YA42 YA42 YA42 YA42 16 13 13 13 28/07/06 30/06/06 30/06/06 30/06/06 Page 26 Guildford Road (2a) Version 5.1 28 YA42 13 and a copy to be held next to the fire alarm system. All cleaning materials must be 25/05/06 stored in a lockable facility at all times. 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 Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Guildford Road (2a) DS0000013481.V294740.R01.S.doc Version 5.1 Page 28 - 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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