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Inspection on 01/08/06 for Aylesham Court Nursing & Residential Home

Also see our care home review for Aylesham Court Nursing & Residential Home for more information

This inspection was carried out on 1st August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents live in a well run, safe and pleasant environment and all the residents, visitors and staff spoken with were happy and positive about the home, the food, activities and the care given. The staff appeared to be committed to the care of the residents and were observed spending individual time with them and delivering good care. `I wouldn`t want to live anywhere else` Staffing levels are good and they were found to be knowledgeable about the safeguarding of adults, the medication policy and the care needs of the residents. This ensures that the residents receive the appropriate care delivered safely by knowledgeable staff.

What has improved since the last inspection?

Risk assessments for residents with swallowing difficulties are in place. The residents have their moving and handling needs assessed within 24 hours of their admission to the home. All the previous recommendations about financial security and information held in care plans have been addressed.

What the care home could do better:

Consideration could be given to reviewing the Registered Nurse hours available to provide for the nursing needs of the residents.

CARE HOMES FOR OLDER PEOPLE Aylesham Court Nursing & Residential Home 195 Hinckley Road Leicester Forest East Leicestershire LE3 3PH Lead Inspector Thea Richards Unannounced Inspection 1st August 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 Aylesham Court Nursing & Residential Home DS0000001886.V304820.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. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aylesham Court Nursing & Residential Home Address 195 Hinckley Road Leicester Forest East Leicestershire LE3 3PH 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) 0116 2395599 0116 2395982 www.bupa.com BUPA Care Homes (BNH) Limited Mrs Amanda Dudd Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (14), Physical disability of places over 65 years of age (60), Terminally ill over 65 years of age (60) Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person under 55 years falling within category PD may be admitted to the home. To be able to continue to accommodate the named person in category PD who is under 55 years of age, subject of variation application V10139, who is currently residing in the home as agreed with the previous registration authority. No person who falls within category PD may be admitted to the home when 14 persons of category PD are already accommodated within the home. The registered manager, Amanda Dudd, undertakes regular formal adult protection training. 26th September 2005 3. 4. Date of last inspection Brief Description of the Service: Aylesham Court is a 60-bedded a purpose built care home providing personal and nursing care for older persons. It is located on a main road on the outskirts of Enderby and Kirby Muxloe in Leicestershire and is easily accessed by public transport from the City of Leicester and the County. The home provides residential and nursing care for sixty service users whose care needs fall within the categories of Older Persons and or Physical Disability over 65 years of age or Terminally Ill. The home is arranged over two floors with good access for residents with a physical disability. The first floor is accessed by, either the stairs or a passenger lift. There are bedrooms, lounges and a dining room on both floors. The two spacious lounge areas on the ground floor have an outlook onto the well-landscaped gardens, which are mainly laid to lawn with surrounding shrubbery and have a patio area where the residents can walk and sit. The home has two large dining rooms, which are well decorated, and have a private area where the residents can have a meal with relatives or friends if they wish. The home has fifty-six single bedrooms and two double bedrooms; all have ensuite facilities of a W.C. and wash-hand basin. Many of the ground floor bedrooms open directly onto the patio area. There is information available in the reception area including the Registration certificate from the Commission for Social Care Inspection. The latest copy of the Inspection report from the Commission for Social Care Inspection is available in the managers’ office Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 5 The current fee level ranges from £ 500.00 p.w. to £ 650.00 p.w. There are additional costs for individual expenses such as personal toiletries, optician, hairdressing and some recreational activities Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the home that was concluded with an unannounced visit to the home. Prior to the visit the inspector spent four hours reviewing the previous inspection report and information relating to the home received since the last inspection on the 26th of September 2005. The visit took place on the 1st August 2006 from 09:30 and lasted four and a half hours. During the course of the visit the inspector checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called ‘case tracking’. Case tracking means that the inspector looked at the care provided to four residents living at the home, by talking to the residents themselves; talking with staff supporting their care; checking the records relating to their health and welfare; viewing their personal accommodation (with their consent) as well as communal living areas. The inspector also checked other issues relating to the running of the home including health and safety, management and staffing areas. During the visit the inspector spoke with other residents in the home, staff, visitors and the manager. The inspector also observed care practices when staff assisted residents. What the service does well: The residents live in a well run, safe and pleasant environment and all the residents, visitors and staff spoken with were happy and positive about the home, the food, activities and the care given. The staff appeared to be committed to the care of the residents and were observed spending individual time with them and delivering good care. ‘I wouldn’t want to live anywhere else’ Staffing levels are good and they were found to be knowledgeable about the safeguarding of adults, the medication policy and the care needs of the residents. This ensures that the residents receive the appropriate care delivered safely by knowledgeable staff. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 7 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. Aylesham Court Nursing & Residential Home DS0000001886.V304820.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 Aylesham Court Nursing & Residential Home DS0000001886.V304820.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): 3, 6 is not applicable in this home Quality in this outcome area is good. This judgement has been made using the available evidence. Residents’ needs are well assessed prior to moving into the home by the completion of a pre-admission assessment by a trained member of staff and by Social Services where appropriate and a visit to the service. EVIDENCE: The inspector checked the care records of four residents who were case tracked. Completed pre-admission assessments were present in the residents files, identifying their needs, prior to their admission to the home. Care plans reflected the needs of the resident identified in the pre-admission assessment. Staff spoken with said that they were aware of the residents needs prior to them moving into the home. The residents and the visitors spoken with said that they had had a visit from somebody from the home before their admission and had the opportunity to visit the home. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 10 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 outcome group is good. This judgement is made using the available evidence including a visit to the service. The staff fully meet the care needs of the residents as identified in the care plans. EVIDENCE: Care plans for four residents were ‘case tracked and were found to contain good individual evidence of care, which reflects the care being given to the residents. This includes a regular assessment of the residents weight and their nutritional needs. There is documentation of the involvement of G.P.s, chiropodist, optician and dentist present, giving evidence of comprehensive care being provided for the residents. The daily record of care is up to date which ensures that there is updated continuity of the care for the residents. Staff spoken with were aware of the care needs of the residents and the residents and the visitors spoken with were happy that all care needs were being met. Medication records for the case tracked residents were in order. Medicines are only administered by qualified nurses in this home. Staff were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. The pharmacist who supplies the home completes six monthly audits, which were Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 11 satisfactory. The above ensures that the residents are protected with the correct medicine administration. There is a policy and risk assessment in place for the residents who look after their own medicines. The inspector observed residents being treated with dignity and respect when staff spoke with them, assisted them at lunchtime and provided care, which include moving and handling the residents. The residents spoken with were happy with the way staff treated them and said that they were very kind. ‘ I wouldn’t want to be anywhere else’. Two visitors spoken with on the day of the visit were very happy with the level of care being given, they had had the opportunity of visiting the home prior to their relative being admitted and had a visit from a member of staff from the home. They were aware of the procedure to follow if they had a complaint or concern and would have no anxiety in doing so. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 12 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 group is good. This judgement is made using available evidence including a visit to the service. The residents have their social, spiritual and nutritional needs met. EVIDENCE: There are comprehensive entries in the care plans of the resident’s involvement in activities, both in a one to one situation and in group activities, which provides occupation and stimulus for them, giving a better quality of life. Included in the care plans is a ‘Life Plan’ which identifies important events and interests in the residents life, which enables the staff to have a wider knowledge of that resident and help them to maintain an interest in any activity that they had prior to coming into the home. A dedicated activities organiser is employed who arranges appropriate activities for the residents and has a good programme in place. There is a choice of meals available and diabetic and vegan meals are provided, if there was a need for other diets the home would be able to provide them. There is a five week rotation of the menu, which gives the residents a good choice in their meal selection. Residents spoken with all said that they enjoyed the food and were happy with the choices, if there was nothing that they wanted on a particular day they were able to select something else. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 13 Visitors are made welcome in the home and some regularly take their relatives out. This was confirmed by visitors spoken with who told the inspector that they were made very welcome at any time. Families and friends are invited to meetings to express their views and are spoken to regularly on a one to one basis by the manager. The manager sees each of the residents on a one to one basis every day. There are regular quality audits undertaken to gain the views of the residents and their families. These practices ensure that the residents maintain contact with the community and their families and that views for improvements can be considered. There is a weekly church service with communion in the home and the local Roman Catholic church arranges visits for those residents of that faith. There are currently no residents in the home with differing cultural or ethnicity needs. The pastoral care needs of the residents are fulfilled. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 14 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 group is good. This judgement has been made using available evidence including a visit to the service. There are systems in place to support and protect residents and staff are knowledgeable about the processes. EVIDENCE: There is a complaints policy in place which is available in the reception area. Those areas of concern which have been identified since the last inspection on 26th September 2005 have been dealt with appropriately. The residents spoken with were happy that they would speak to the manager or a member of staff, if they had a problem. Visitors spoken with on the day of the visit said that they were aware of the procedure to complain and would have no concerns about doing so. The Commission for Social Care Inspection has received no complaints or concerns since the last inspection. The staff have received training in ‘Safeguarding Adults’ and those spoken with were aware of the procedure to follow and would be prepared to ‘whistle blow’ if they thought there was a need to. This was confirmed by available documentation, the staff spoken with and the manager. This ensures that the residents are safe from any abuse and that any concerns are handled correctly. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 15 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, 20,22, 23, 24, 25, 26 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The residents live in a wellmaintained and safe environment. EVIDENCE: The Registration Certificate from the Commission for Social Care Inspection was displayed in the reception area. The current inspection report is available in the managers’ office. Aylesham Court is a purpose built home owned by BUPA. It has a large and welcoming reception area, which leads to the lounges and dining room. These are comfortable and welcoming with a selection of chairs to suit the residents’ needs, they are well maintained and clean and provide a pleasant environment for the residents to live in. There are several lounges, which enable the residents, a choice of sitting areas. The bathrooms are clean and free from inappropriate items, which could present a hazard for the residents. One of the bathrooms is currently out of use as the home is waiting for a temperature control valve for the residents’ safety. However there remain sufficient bathing facilities for the residents’ use. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 16 With their pemission the case tracked residents bedrooms were viewed by the inspector. They provided good accommodation with en-suite facilities of a W.C. and wash-hand basin. They had been personalised with the resident’s belongings and a resident spoken with was delighted that ‘it made it feel more like home’. The bedrooms were clean and well maintained. The majority of the ground floor bedrooms lead out onto level access to a patio and garden which enables the residents to sit outside. There was evidence of equipment such as hoists and special mattresses having been provided to help in the care and comfort of the residents. There were no outstanding safety or maintenance issues noted in the premises. Records for the maintenance of fire equipment, fire-drills and testing of water temperatures were found to be in order. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 17 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 group is good. This judgement is made using the available evidence including a visit to the service. The residents’ needs are met and their safety protected by a robust recruitment policy and a good staff training programme. EVIDENCE: There is evidence of a good skill mix of staff to give the care identified for the residents needs and the number of staff on duty reflected the duty rota. Residents, staff and visitors spoken with felt that there were always sufficient numbers of care staff on duty to cater for their needs. Registered Nurses spoken with felt that consideration could be given to increasing the available qualified staff hours to cope with the nursing needs of the residents. Two staff files were viewed by the inspector and the required documentation was complete in both files. This included evidence of identification, adequately completed application forms, two written references and Criminal Records Bureau checks. There was evidence of staff training including induction and the staff spoken with confirmed that they received regular training in fire,first aid and moving and handling. There was the availability of non mandatory courses which the staff could access such as syringe driver training, for qualified staff administering medication for terminally ill residents and diabetic training. Sixty per cent of the staff had completed a National Vocational Qualification in care at level two or above, which is to be commended. Several more staff were about to commence the training. The National Vocational Qualification is Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 18 a qualification for care staff to ensure that they receive appropriate training in the needs of the resident group whom they are caring for. Aylesham Court Nursing & Residential Home DS0000001886.V304820.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, 38 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The residents live in a home, which provides for their needs, with good safety systems in place. EVIDENCE: The manager was available throughout the visit to the home . The regular inhouse audit of the home was in progress during the inspection. The manager has worked in the home for two and a half years as the the manager of the service and has worked with BUPA for several years progressing from working as a Registered Nurse to her present position. She has completed a Registered Managers’ Award which is a requirement for registered managers through the National Vocational Qualifications. This ensures that managers have the required skills to manage a care home. She has also achieved a National Vocational Assessors award which enables her to assess the staff in the home for their qualifications. She is well supported through BUPA and has attended many ‘in-house’ training courses. She is supported on a day to day basis by a deputy home manager and a clinical supervisor. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 20 The staff receive appropriate training to equip them to care for the residents safely whilst protecting them from any abuse. This was confirmed by available documentation, the manager and by staff spoken with. There was evidence of regular staff supervision taking place which gives the staff and their ‘line manager’ the opportunity to have individual discussions about work and training needs. There are regular staff meetings held to pass on information and exchange views. The manager holds regular meetings with the residents and their families as well as one to one discussions with them both to pass information on and to listen to their views and opinions. There are regular quality questionaires sent out to residents and their families to gain their views about the home. Residents finances are handled by their families with the home holding some monies on their behalf for incidental expenses. This is held in a non interest account with statements of expenditure produced. This is handled by the manager and the administrator with good records in place and two signatures required for each transaction. The residents are well protected by the financial policies in the home. Residents needs are met by the manager who is well supported by BUPA who own the home and who will supply equipment for the use of the residents, which ensures that the residents receive appropriate support and care. There are appropriate records in place confirming that all health and safety requirements are being met to maintain a safe environment for residents and staff. The accident book was inspected and found to be complete and in order. Aylesham Court Nursing & Residential Home DS0000001886.V304820.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? None 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. Standard Regulation Requirement Timescale for action 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 OP27 Good Practice Recommendations The registered person could give consideration to reviewing the Registered Nurse hours available. Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 Aylesham Court Nursing & Residential Home DS0000001886.V304820.R01.S.doc Version 5.2 Page 24 - 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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