Inspection on 28/11/06 for Astral Lodge Residential Home

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 but made no statutory requirements on the home.

Other inspections for this house

Astral Lodge Residential Home 12/11/07

Astral Lodge Residential Home 21/09/05

Astral Lodge Residential Home 09/05/05

Astral Lodge Residential Home 10/01/05

Astral Lodge Residential Home 06/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Astral Lodge Residential Home 35 Ailsa Road Westcliff On Sea Essex SS0 8BJ Lead Inspector Christine Bennett Key Inspection 28th November 2006 09:15 X10015.doc Version 1.40 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 Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 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 Older People. 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. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astral Lodge Residential Home Address 35 Ailsa Road Westcliff On Sea Essex SS0 8BJ 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) 01702 345409 01702 340262 Mr Navneet Singh Johar Mrs Aunjali Johar Position Vacant Care Home 14 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (14) of places Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Number of service users to whom personal care is to be provided shall not exceed 14 (fourteen). Accommodation and personal care may be provided to no more than 14 older people over the age of 65 years (OP). Accommodation and personal care may be provided to no more than 4 service users over 65 with Dementia (DE(E)). Total number of persons over 65 years to be accommodated must not exceed 14. 21/09/05 Date of last inspection Brief Description of the Service: Astral Lodge is a small family run care home. It is registered for fourteen male and female people age sixty five years and over. The home is registered for up to four people with dementia within this number. The home is conveniently located in a pleasant residential area of Westcliff which is within easy access to shops, bus routes, main line stations, the seafront and Southend and Leigh town centres. Accommodation is provided on two floors with ten single bedrooms and two twin bedrooms. Residents can access the first floor via a passenger lift. A copy of the Statement of Purpose and the last Inspection Report are displayed in the hall at the entrance of the home. A copy of the Service User Guide is displayed in each bedroom. Fees as at April 2006 range between £375 - £495 per week. Extras charged are for chiropody, hairdresser, toiletries and newspapers/magazines. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key site visit was unannounced and took place on 28th November 2006 and lasted over an eight hour period. At this inspection all the key standards and the progress made since the last inspection were assessed. A pre inspection questionnaire had been completed by the home. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. Surveys had been sent to a random selection of residents and visitors. Five responses were received from residents, and six from visitors. Their comments are included in this report. A general practitioner and a district nurse who visit the home also returned surveys and had no concerns regarding care in the home. At the site visit a tour of the premises took place. Time was spent with the residents in the lounges and dining room, and some residents and a visitor were spoken with individually. Care practices were observed throughout the day. The manager and registered provider assisted during the inspection and staff were given the opportunity to speak to the inspector. Feedback was given to the manager and registered provider throughout the inspection. What the service does well: Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 6 The home has a stable staff team who know the residents well. All the residents spoken with were happy with their life at the home. One relative commented, “I find Astral Lodge very warm and friendly towards residents and visitors. The staff are very caring and make you very welcome”. The residents have the opportunity to join in an activity and exercise session every day. Visitors are encouraged to join in some of the activities organised by the home. The home operates a thorough pre admission assessment to make sure that residents know what the home can offer and to make sure that the home can meet their needs. What has improved since the last inspection? What they could do better: Some areas of the home are in need of refurbishment. There are a few areas in the recording of medication that need to be improved to make sure of accuracy. The home should collect information it has received from residents, relatives and anybody else involved with the home and produce evidence that it has listened to peoples views and made appropriate changes. Some staff are in need of updated training to give them the skills to do their job. Bins must have lids to prevent the spread of infection. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 7 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. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move into the home. EVIDENCE: The home has an up to date Statement of Purpose and Service User Guide, which include the fees charged, by the home. The Statement of Purpose is available in the hallway of the home, together with the last inspection report. A copy of the Service User Guide, which includes a copy of the terms and conditions, is available in each resident’s bedroom. All the residents responded in the survey that they felt that they had received enough information before moving into the home and had a copy of the terms and conditions. This was evidenced in a care plan viewed at the site visit. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 10 The registered provider described a thorough pre admission assessment, whereby a senior member of staff visits the prospective resident in their own home and takes a detailed history. An assessment is also requested from the social worker or the family, if the person is privately funded. At this stage a brochure of the home is given to them. The resident and their family are invited to visit the home and spend time there to ensure that they make an informed choice. A copy of the needs assessment was seen in the care plan of a resident. This contained detailed information and identified the needs of the individual. The home does not offer intermediate care. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Care plans and the delivery of care ensure a resident’s needs are met. Medication recording needs to be improved to ensure the accuracy of medication held in the home. EVIDENCE: Residents and visitors were very happy with the care being given in the home and were complimentary about the staff team. Details recorded in the care plans were clear and gave the information needed to meet individual needs. A visitor said that she is sometimes involved in the care plan and is always notified of any medical appointments her relative has to attend. Some residents indicated in the surveys that staff are not always available when needed. Comments made were “sometimes a delay if they are very busy”, “there is no one to talk to for long periods of time” and “sometimes have to wait too long to be toileted”. Other residents’ felt that staff were always available – one commented, “they are always around”. Staff spoken with felt that time taken with cleaning and cooking meant they did not always have the time to spend with residents. The manager agreed that this is an area that she plans to review. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 12 Evidence was seen of input from other health professionals such as the GP or the district nurse. At the site visit, one resident had been taken out by a member of staff for a blood test, and the falls coordinator was visiting the following day to assess a resident who had fallen twice in recent weeks. Another resident described how the home had found her a dentist and arranged appointments for her treatment. All the residents who responded in the survey felt that they received the medical support that they need. Nutrition charts should be developed to indicate how much an individual eats, and the manager agreed that this would be actioned. The medication system in the home is generally good. Areas identified at the previous site visit had been rectified. Some recording practices must be improved to ensure the accuracy of medication held in the home. The registered provider and manager agreed to liaise with the GP and pharmacist to achieve this outcome. Residents felt that their privacy and dignity were respected. Staff were seen to knock at doors before entering. The home has a visitors’ room and a pay phone for residents. At the site visit a member of staff was seen to give a resident the home phone to take an incoming call in private. Post is given to residents unopened and each resident has an individual laundry basket to ensure they get their own clothes back. At the site visit it was noted that disposable gloves are on display in residents’ bedrooms and other public areas. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A full range of activities in the home and community mean the residents lead a stimulating life. Meals and mealtimes are an enjoyable occasion for the residents. EVIDENCE: Discussion and survey results identified that most residents are happy with the level of activity within the home but would like the opportunity to go out more. An exercise session is held every morning and in the afternoon there are various activities. An activity was observed at the site visit. This consisted of a quiz and singing. It was held in the main lounge and the residents were very involved. When it had finished, the carer came into the small lounge and did some of the quiz questions with these residents to make them feel included even though they had chosen not to join the big group. There was a very nice relaxed atmosphere in the home. An activities person has recently been appointed and residents’ views have been sought and arrangements are in place to fulfil some of the requests. A party with an entertainer had recently been held to which relatives had been invited and plans were underway for the Christmas party. Extra help was being provided to enable the residents to go out more and any activity is now recorded on an individual file. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 14 Residents were complimentary about the food supplied by the home. A choice is given at each meal and the home operates a four weekly menu. The dining tables were attractively laid out and lunch and tea were seen to be a pleasant sociable experience. Care staff were seen to spend time talking to the residents as they served their food. One resident confirmed that the staff gives her soft food at her request, and food seen was of a good quality. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel safe and are protected by the home’s complaints procedure. EVIDENCE: The home has a satisfactory complaints procedure. This is detailed in the Service User Guide. There have been no complaints recorded since the last inspection. The home has a compliments book at the entrance to the home and intends to provide a suggestion box for residents and visitors. Surveys received from residents all felt that they knew who to speak to if they were unhappy and felt confident in doing so. One resident commented, “I’d speak up if anything was wrong”, and a visitor said that she felt confident that any complaint would be sorted out. Staff spoken with had a good knowledge of different forms of abuse and how to report suspected abuse. One allegation of abuse had been made since the last inspection, but this had been investigated by Social Services and was unfounded. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents live in a safe, clean homely environment. EVIDENCE: The home has a pleasant atmosphere and was generally clean, tidy and odour free. A visitor described it as “nice and homely”. Two bedrooms were identified where odour control was not being successfully managed. This was discussed with the manager and the registered provider. A maintenance person is available to undertake maintenance tasks and carry out safety checks. There were various areas in the home that were in need of attention. These included absent toilet roll holders, a broken bedside cabinet, a hall carpet that was in need of stretching to prevent it being a trip hazard and many curtains to be repaired/replaced. The registered provider explained that a redecoration programme is in place for the bedrooms. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 17 Kitchen cupboards and work surfaces have been replaced since the last inspection. Some new bedroom furniture and lounge curtains have been bought. The fire exit on the first floor has been updated in line with regulation and hazardous areas such as the doors leading to the balcony have been made safe. Radiator covers are in place in resident’s bedrooms but access must be made available for them to control the temperature. Records are available for the recording of hot water taps and running of unused taps. Hot water checked randomly was being delivered at a safe temperature. There were many areas in the home that had open bins, including the bedrooms. One bin had a soiled pad exposed in it. New guidance for care homes in relation to infection control procedures was discussed with the manager and registered provider Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has improved its recruitment process and has plans for staff training. This provides better outcomes for people using the service. EVIDENCE: The home is fully staffed. Care staff do the cooking, cleaning and laundry in the home. Agency staff are not used and sickness and annual leave are covered by the staff team. Staff spoken with were positive about working in the home and said it is a good staff team. Some felt that time spent doing household chores meant they could not spend as much time as they would like with residents. The recruitment file was seen for the most recent member of staff to join the team. References had been obtained and a POVA 1st obtained before she commenced work. Training files were seen for staff and 50 have obtained NVQ 2 or above. All staff are having manual handling training in November 2006. There are some areas where staff need updating or have training needs. The manager intends to identify individual needs and arrange appropriate training to ensure they have the skills to perform their role. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New management arrangements are meeting the needs of the service. EVIDENCE: The home has recently appointed a new manager after a period of approximately five months without a manager in place. Staff were positive about this appointment, as, despite good support from the registered providers and area manager, they felt more confident with a manager in place. This person is a Registered General Nurse and intends to obtain a management qualification when her probationary period ends. Staff meetings have lapsed since the previous manager left, but the manager was arranging a meeting imminently in order to introduce herself formally and find out staff views. Residents meetings have been held and the minutes of the last one was available on the residents’ notice board. The registered Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 20 provider has also introduced a comment sheet for residents in order to gain their views between meetings. A visitors’ survey had been completed earlier in the year. Regulation 26 reports are completed by the area manager. The provider must collect the results of all the information gleaned from these avenues and provide an annual report on how the service is meeting the aims and outcomes for residents. This should be made available to CSCI and to the residents in a suitable format. Money/valuables belonging to the residents are stored securely. Financial transactions are recorded individually and files checked at random were accurate, with receipts available. The manager and registered provider are in the process of updating the method of recording money held by the home. Since the last inspection the home has improved the safety measures. Recording of water temperatures/running taps is now done regularly. Hot water checked randomly in residents’ bedrooms was being delivered at a safe temperature. COSHH products were locked in the laundry and the doors leading to the balcony were locked. Safe working practice must be available in the laundry and kitchen area. Evidence was seen of emergency lighting and fire alarm checks. The fire exit on the first floor has been upgraded and fire drills have taken place, which included the night staff. A fire risk assessment was completed by the home in February 2006. The home feels it is now fully compliant and the fire prevention officer is visiting the home in January 2007 to confirm that it meets regulation. Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 x X 3 Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Requirement The registered person must make arrangements for recording, safekeeping and safe administration of medication. This is a repeat requirement The registered person must keep the premises/furnishings in a good state of repair. The registered person must keep the home free from offensive odours and make suitable arrangements to prevent infection. The registered person must ensure staff receive training appropriate to the work they are to perform. The registered person must continue to develop a system to review the quality of care delivered and make it available to residents and CSCI DS0000057745.V324223.R01.S.doc Timescale for action 31/01/07 2. OP19 23(2)(b) 31/03/07 3. OP26 16(2)(k) 13(3) 31/01/07 4. OP30 18(1) (c)(i) 31/03/07 5. OP33 24 31/03/07 Astral Lodge Residential Home Version 5.2 Page 23 This is a repeat requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Nutritional charts are developed to include supper and amounts eaten/drunk Gloves/aprons are stored appropriately to protect the safety/dignity of the residents. Radiator covers allow access to enable residents to control the heating in their room Residents are offered lockable storage in their room and documented in care plan. Safe working practice is available in the laundry and kitchen to be readily accessible to staff. 2. 3. 4. OP10 OP25 OP24 5. OP38 Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Astral Lodge Residential Home DS0000057745.V324223.R01.S.doc Version 5.2 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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