Inspection on 07/06/06 for Axbridge Court

This inspection was carried out on 7th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Axbridge Court 07/01/09

Axbridge Court 06/09/07

Axbridge Court 12/12/05

Axbridge Court 08/09/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Axbridge Court West Street Axbridge Somerset BS26 2AA Lead Inspector Justine Button Unannounced Inspection 7th June 2006 09:30 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 Axbridge Court DS0000064451.V298801.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. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Axbridge Court Address West Street Axbridge Somerset BS26 2AA 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) 01179 863997 www.almondsburycare.com Almondsbury Care Limited Mrs Beverley Francis Davies Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is to be registered for 36 nursing beds. Date of last inspection 12th December 2005 Brief Description of the Service: Axbridge Court Nursing Home, formerly the St.Johns Hospital, has been adapted to a two-storey home in the centre of Axbridge, close to the local shops. The home is in shared private grounds and has car parking space. There is a large garden area. The home has a large well appointed communal lounge and dining room. The home has mainly single bedrooms with en-suite facilities. The en-suites enable wheelchair access. There is a passenger lift facility to the first floor. Aids and adaptations have been made to promote mobility in the home. There is a nurse call system through out the home. Health and safety measures include covered radiators and window restrictions. The home is registered to provide nursing care for up to 36 people. Personal care can also be provided within these numbers. The manager is a registered nurse and there is a registered nurse on duty at all times. Axbridge Court was purchased by Almondsbury Care on 23 June 2005. The manager, Beverley Davies, was appointed at the same time. She is a registered nurse with considerable management experience. The owners have undertaken a major refurbishment and improvement programme. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out in line with the CSCI framework ‘Inspecting for Better Lives 2’. This unannounced key inspection was conducted over one day by CSCI Regulation Inspector Justine Button. At the time of this inspection, 30 service users were living at the home. The inspector was able to meet with the majority of service users and staff. Service users were positive about the care they received. Staff stated that they felt well supported. The registered manager was available throughout the inspection. A tour of the premises was carried out where all communal areas and the majority of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. The inspectors would like to thank service users, staff and the registered manager for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: What has improved since the last inspection? Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 6 This is a service, which in the past has had a number of issues. It was purchased by Almonsbury care under a year ago and in this time has improved significantly. Work continues on improving the fabric of the building and the décor. A number of the communal areas and bedrooms have been redecorated and new carpet laid. Care plans have improved although there is scope for further development and staff training and monitoring should continue. The Standex system of care planning documentation has been implemented for all service users. An activities organiser is now in post and is developing a range of social and recreational opportunities. People living at the home stated that they appreciated this development. A deputy manager is now in post. The new deputy and the current manager work well together as a team and continue to develop the service. What they could do better: Whilst it is appreciated that significant amounts of money has been spent on the fabric of the building there are still some areas that require attention. Almondsbury care therefore need to continue this investment particularly in the bathrooms some of which remain in a poor state of repair. Comments from all people about the food were positive, however, no choice at main meals is offered. Staff stated that “people only had to ask and an alternative would be provided”. A number of people living at the home questioned stated that they would not like to bother anybody so would just eat what they were given or leave the meal. The management therefore need to ensure that an active choice is given for all main meals. The home has adequate information, for both new and existing people living at the home, with regard to the services they are able to offer in the form of the Statement of purpose and the service user guide. These documents and the complaints procedure however were not prominently displayed. The management need to ensure that all interested parties have access to this information. The home provides care and support for a number of frail people who were nursed in bed on the day of the inspection. The care of these people was good with staff supporting them with regular changes of position and fluids. In a number of the rooms visited however the toothbrushes and the top of the Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 7 toothpaste were dry. This leads the inspector to believe that staff had not supported people with oral hygiene. This area needs to be addressed by the staff. Improvements in the care planning system were seen, however, some of the comments in the care plans such as “ensure adequate fluids” or “turn regularly” are some what ambiguous. People living at the home and/or their relatives should be involved in the development and the reviewing of the plan. This will ensure that the care and support given is in the manner in which the individual wants their care. 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. Axbridge Court DS0000064451.V298801.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 Axbridge Court DS0000064451.V298801.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, 3, 4 & 5. (Standard 6 is not applicable). The quality for this outcome group is adequate. Prospective service users have the information they need to make an informed choice about moving to the home. The home takes appropriate steps to ensure that an individual’s assessed needs can be met by the home. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide. It could not be confirmed if these are made available to interested parties as they were not prominently displayed within the home. The registered manager provided the CSCI with pre-inspection information which stated that the home’s current fees are £600 per week. Fees are determined upon the assessed needs of an individual. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 10 Any ‘Free Nursing Care’ element awarded is incorporated into the fees and is not refunded to the service user. Extra charges are met by service users for newspapers, hairdressing, trips/outings, personal toiletries/items and special requirements. The home also makes additional charges for transport and for staff time to escort service users to and from appointments. The manager or her deputy visit a prospective service user and carry out an assessment to ensure that the assessed needs and aspirations of the individual can be met by the home. Documented evidence of pre-admission assessments were seen in the care records examined. Assessments from other professionals were also seen in care records. Prospective service users and/or their representatives are invited to visit the home prior to making a decision. Service users move to the home initially on a 4 week trial period. This is to ensure that all parties are happy with the placement. This was confirmed by the most recent service user. Axbridge Court DS0000064451.V298801.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. The quality in this outcome group is adequate. Care planning has improved; care must be taken to ensure clear guidance is given to staff on all occasions. The home must continue trying to achieve more service user involvement. Service users are treated thoughtfully, with respect and are well cared. The home’s procedures for the management & administration of medication is good. EVIDENCE: Six care plans were sampled, personal details and contacts were recorded. Service users had recorded care needs assessments and subsequent reviews of care. The plans of care related to the care given for people who live at the service (case tracking). There was evidence in the care plans of input by the community health care professionals such as the chiropodist, dentist, optician Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 12 and continence advisor. Out patient appointments and GP visits were recorded. Staff need to avoid ambiguous statements in the care plans. Statements seen included “ensure adequate fluids or turn regularly”. The plans of care need to be specific e.g. how much fluid or how frequently the person needs support to change position. The registered nurses need to ensure that the use of medical terminology is avoided. Both of these measures will ensure that clear guidance is given to care staff. There was limited evidence that individuals living at the service have been involved in the development and review of the plans. This is seen as good practise and helps to ensure that people have care delivered in the way that they would wish. Pressure relieving equipment was seen in use and all manual handling was risk assessed for the individual service users in their care plans. Service users who were spoken with confirmed that they felt well cared for and that they are treated with dignity. Staff were observed knocking on bedroom doors prior to entering. The homes procedures for the management and administration of medication was examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). Medicines are administered by the registered nurse on duty. Medicines were found to be securely stored. MAR charts were completed to a good level. A monthly drug audit is completed by one of the Registered Nurses. This ensures that any issues in this area are identified quickly. Axbridge Court DS0000064451.V298801.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. The quality for this outcome group is adequate. There are some activities on offer although this area needs to continue to be developed. People living at the service are able to meet and welcome visitors. Meals are varied and nutritious but a choice is not available at lunch times. EVIDENCE: Activity provision has improved recently. The documentation with regard to the activities undertaken was viewed on the day of inspection. Activities on offer included bingo, arts and crafts, hairdressing and film afternoons. From the documentation seen it appeared that the same people attended the majority of activities. Staff need to ensure therefore that the range of activities is increased (including those seen for 1 to 1 time) to include those who are less able. The activity organiser stated that she was looking to increase the range of activities on offer, she is due to attend a course on reminiscence in the near future and introduce this activity on a regular basis. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 14 Visitors were seen and all said that they felt welcomed. Satisfaction with the care of their relatives was expressed. Lunch was observed during the inspection. People who live at the service stated that the meals were of good quality and enjoyable. A choice of menu is not routinely offered although some people said they would ask for an alternative if they did not like what was served. Some people however stated that they would just leave the meal if they did not like it as “they would not like to bother anybody”. The management need to ensure therefore that a choice is actively offered. Special diets are catered for. The inspectors observed soft diets being served to those with an assessed need. These were seen to be attractively presented. Sweets were available for those requiring a diabetic diet. Staff were observed assisting service users in a manner which was relaxed, unhurried and respectful. The kitchen was clean and tidy. The cook stated that she had an adequate budget and provided home cooked food including cakes and puddings. There was is a set rolling menu however this is changed by the cook to incorporate “what is in season and what looks good at the butchers”. Axbridge Court DS0000064451.V298801.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. The quality for this outcome group is adequate. The home has a complaints procedure. It could not be confirmed if this was accessible to people in the home. People living at the service are protected from abuse with the homes policies and procedures and practice. EVIDENCE: No formal complaints have been received since the last inspection in December 2005. The service has a complaints procedure however this was not on display on the day of the inspection. The management need to ensure that this is accessible to all interested parties. People spoken to on the day of the inspection however stated that the manager and staff were very approachable and they would feel comfortable raising any concerns. Staff are made aware of the home’s whistle blowing policy and information on ‘elder abuse’. Axbridge Court DS0000064451.V298801.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, 20, 21, 22, 23, 24, 25 & 26. The quality in this outcome group is adequate. The standard of décor in the home has improved and improvements are ongoing. Service users live in a comfortable & clean environment and have access to a range specialised equipment. The home takes appropriate steps to reduce the risk of the spread of infection. EVIDENCE: A tour of the building was conducted during the inspection. The home was clean and tidy on the day of the inspection. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 17 The bedrooms seen showed a degree of individuality with personal possessions being evident. There is a range of communal lounges and a large dining room. All areas were well used by people living at the home during the inspection. The gardens were pleasant and well maintained. People who the inspector spoke to stated that they enjoyed sitting out in the summer months. The inspector observed that substantial work has been undertaken to improve the environment of the home. At this inspection the corridors and hallways had been decorated. Considerable investment is being made in the infrastructure of the home as well as cosmetic improvements. Whilst it is appreciated that significant amounts of money has been spent on the fabric of the building there are still some areas that require attention. Almondsbury Care therefore need to continue this investment particularly in the bathrooms some of which remain in a poor state of repair. All areas of the home were noted to be clean. No malodours were apparent. The home takes appropriate steps to reduce the risk of the spread of infection. Hand washing facilities are appropriately sited throughout the home and staff have access to protective clothing. Axbridge Court DS0000064451.V298801.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. The quality in this outcome group is good. The home has a dedicated core staff team. There are sufficient numbers of staff on duty. Recruitment policies and practise are in line with good practise guidelines. Staff training is adequate. EVIDENCE: At the time of this inspection, 30 service users were living at the home. Staffing levels are currently adequate to meet the numbers and assessed needs of the 30 service users at the home. The registered manager informed the inspectors that staffing levels would be increased to reflect any increase in service user numbers or any increase in assessed needs. Copies of a two-week staffing rota were made available to the inspectors. As a minimum, one registered nurse is on duty during the day and night with the following care staff; 6 in the morning, 4 in the afternoon, five in the evening and 2 at night. Staff spoken with during the inspection did not raise any concerns about staffing levels. Given the large physical lay out of the Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 19 home and the needs of the service user group consideration should be given to increasing the number of staff on nights. Staff have received manual handling, fire training ,food hygiene training and dementia care. Staff spoken with during the inspection were positive about the training opportunities available to them. Staff also indicated that they had received appropriate training to enable them to meet service users’ assessed needs. One staff member has been employed since the last inspection. The recruitment file for this individual was examined. This contained all appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. Enhanced CRB checks and POVA checks were also in place. Newly appointed staff follow a TOPPS induction programme. This covers the initial induction programme and on-going training for staff. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 20 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, 32, 33, 34, 35, 36 & 38. The quality in this outcome group is good. Service users and staff benefit from an effective management team who promote an open and inclusive style of management. The home’s procedures for ensuring the health & safety of service users and staff have improved. EVIDENCE: The chief executive makes regular visits to the home and completes detailed Regulation 26 reports. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 21 The manager is enthusiastic and competent and has made significant progress in improving the running of the home. The appointment of a deputy manager has greatly assisted her. At the time of this inspection, the home was taking appropriate steps to ensure the health & safety of service users, staff and visitors to the home. The following records were examined: FIRE – Records indicated that appropriate checks were being carried out on the home’s fire detection and fire fighting equipment. Regular training is conducted for all staff. Emergency lighting is tested monthly. SERVICING – A full range of servicing had been undertaken. Certificates were seen for the home’s electric hard wiring and gas supply. Hoists were serviced by an outside contractor in accordance with LOLER regulations. BEDRAILS- are in use for those service users with an assessed need. There is now a system of assessing and maintaining all rails to ensure they comply with the MDA guidance. ACCIDENTS – The home maintains records relating to accidents at the home. The manager has begun an analysis of accident records to identify any traits. HOT WATER/SURFACES – All radiators are of a low surface temperature type which reduce the risk of injury to service users. Bath hot water outlets are thermostatically controlled to reduce the risk of scalding. Those checked at this inspection were found to be within the acceptable limits although it was evident that there had been issues with the provision of hot water and heating. The manager stated that substantial monies are due to be spent on the hot water and heating systems. Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 22 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 2 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 1 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement The care plans must be developed to ensure that they reflect the full range of service users needs and must give clear direction to staff of the action to be taken to meet these needs. Service users and or their representatives are involved in the development and review of the plans. PREVIOUS TIMESCALE 01/05/06 2. OP21 23 (2) (J) It is required that a programme for the refurbishment of the bathrooms must be developed and submitted to the CSCI. It is required that a system is developed to ensure that all people in the home are supported with oral hygiene. 30/08/06 Timescale for action 28/09/06 3 OP8 12 (1) (a) 30/08/06 Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 24 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 OP12 Good Practice Recommendations A programme of social activities based on the requirements of service users should continue to be developed. Consideration should be given to providing an active choice of main meal. The management need to ensure that the Statement of purpose, service user guide and complaints procedure are on display. 2 3. OP15 OP1 Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Axbridge Court DS0000064451.V298801.R01.S.doc Version 5.2 Page 26 - 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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