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Inspection on 03/01/06 for Bramble Cottage Retirement Home

Also see our care home review for Bramble Cottage Retirement Home for more information

This inspection was carried out on 3rd January 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.

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

What has improved since the last inspection?

Since the last inspection the home has met the requirement made and self medication procedures are now in place. Staff supervision has commenced and records are kept of these.

What the care home could do better:

Some requirements have been made, and although are more than in previous inspections are relatively minor and point to either matters having been overlooked, or regulation misunderstood. Some medications must, when used in a care home, be treated as a controlled drug. Recent drug audits had not identified this and the manager was therefore unaware of this. A window restrictor was broken and this must either be replaced or risk assessed. However all other window restrictors were in place. One resident had acquired an electric fan, this had not been risk assessed, as the manager was not aware that it had come into the home. Staff were seen entering the kitchen without protective clothing although this was provided and the manager must be vigilant over this. One member of staff had been employed prior to a second written reference being provided. This is one of the key employment regulations to ensure safety of residents and therefore a requirement had to be made relating to this. Some points such as room number of the room to be occupied and for which part of the fees the resident is liable are required to be added to the terms and conditions for residents. It is recommended that the length of trial period be identified in the terms and conditions for the protection of the owner and residents. Overall the home meets the standards and appears to provide a good standard of care in exceptionally pleasant surroundings.

CARE HOMES FOR OLDER PEOPLE Bramble Cottage Retirement Home 18 Carden Avenue Brighton East Sussex BN1 8NA Lead Inspector Elizabeth Dudley Unannounced Inspection 3rd January 2006 10:00 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 Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 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. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bramble Cottage Retirement Home Address 18 Carden Avenue Brighton East Sussex BN1 8NA 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) 01273 565821 Bramble Care Homes Limited Mrs Diana Shaw Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-eight (28). Service users will be older people aged sixty-five (65) years or over on admission. 22nd August 2005 Date of last inspection Brief Description of the Service: Bramble Cottage is registered to provide accommodation and personal care for up to 28 older people. The registered provider is Bramble Care Homes Ltd. The responsible individual is Mr M. Newman. The registered manager is Diana Shaw. The home is located in Brighton with access to local amenities. It is set out over three storeys and has a passenger lift to all floors. There are 26 bedrooms, all of which have full en-suite facilities. There is a good range of communal space, including a main lounge, dining room and large rear garden. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 3rd January 2006 and forms part of the annual inspection programme for this home. The inspection was conducted over a period of four hours and was facilitated by Ms D Shaw, registered manager. During the course of the inspection, a partial tour of the home was undertaken, catering records, care plans, health and safety records and personnel files were examined, and sixteen residents, eight staff and three visitors were spoken with. Positive comments about the home were received from visitors, residents and staff. Residents stated that ‘It is a lovely home’, ‘The staff are so kind’, ‘it’s a wonderful place here’, ‘I am so glad I found this place’. Visitors said that the home was lovely and that their relatives were well looked after. It was also stated that the ‘Manager is wonderful’. ‘ The staff are exceptional’. Staff felt that it was a good place to work and that they related well to the manager and the owners. All residents looked well cared for. Thanks are extended to the manager, residents, staff and visitors for their courtesy and help during the day. What the service does well: The home is exceptionally well presented with very pleasant rooms. Décor and maintenance is good and the gardens are landscaped to a high standard and present an interesting view. All residents rooms were in good decorative order and extremely clean and comfortable. A comprehensive range of activities is provided and residents are encouraged to maintain their interests and an active lifestyle. Sherry or gin and tonic is offered at lunchtime, and meals are taken in a pleasant dining room. Residents stated that the standard of catering is good. Staff are experienced and enthusiastic and staff turnover is low. Christmas decorations were in place and the home was very festive. It was apparent that the staff had gone to a lot of trouble to provide residents with a good Christmas and had put on a pantomime. Residents were very enthusiastic about this. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 6 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. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 7 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 Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 8 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): 1,2,3,4,5 The home provides appropriate documentation and sufficient opportunity for prospective residents to be able to decide whether they wish to live at Bramble Cottage. EVIDENCE: Bramble Cottage produces a comprehensive statement of purpose and service users guide. All residents are provided with a copy of the service users guide when they take up residence at the home along with a statement of terms and conditions of residence. In order to meet this standard, the statement of terms and conditions requires the addition of number of the room to be occupied and the breakdown of the amount of fees that the resident is liable to pay. This is apparent when the resident is self-funding, but requires identification when the funding is split between the resident or social services department or is entirely funded by social services. Although the manager states that there is verbal affirmation that all residents are admitted on a month’s trial, it is recommended that this be put in writing in the statement of terms and condition, for the protection of both the service provider and the residents. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 9 All residents are assessed by the manager prior to being admitted to the home. Most prospective residents visit the home to look around and meet the other residents and the assessment is undertaken at this time, not only does this process ensure that the home can meet the needs of the resident, but prospective residents will need confirmation of this in order to decide whether to make Bramble Cottage their home. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 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, The care plans address the care to be given in enough detail to ensure that the assessed needs of the residents are met. Evidence of resident involvement is needed in care plans to show that residents are aware of the care that is being planned for them. Records and storage of Temazepam and Morphine based drugs must be in line with current legislation in order to fully protect residents. EVIDENCE: A sample of eight care plans were examined in detail and these appeared to address the assessed care needs including social care needs. Some of the care plans included a personal history of the resident. The care plans showed that they had been reviewed on a monthly basis and included risk assessments relevant to individual residents. However some care plans did not show any evidence that the resident or their representative had been involved in the formation of the care plan, and this must be addressed. Likewise although the home no longer uses hoists on residents, care plans had not been amended to identify the new lifting equipment. The home accesses the local GPs to attend to the medical needs of the residents, although residents can keep their own GP’s and dentists, if local to Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 11 the area. District Nurses attend to the nursing needs of the residents as required. There are systems in place for safe administration of medicines, including risk assessments for residents that self medicate. The pharmacy that supplies the home undertakes medication audits and training for staff. However it was noted that Temazepam, which must be treated as a controlled drug in care homes was being kept in the drug cupboard alongside non-controlled drugs and was not being double signed or the quantity checked, likewise Oromorph, although being kept in a separate locked cupboard was not being double signed or the quantity checked. The home must account for any controlled drugs in a book with numbered pages, or a controlled drug register. Lactulose, originally prescribed for a resident, was being used for another resident, this was evident by being relabelled with a room number only. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 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 The home provides a very varied programme of activities and encourages residents to pursue both past and present interests. All residents can make choices around the activities of daily living and have visitors at most times of day. A good standard of catering is in place. The home provides a good quality of life for residents. EVIDENCE: A variety of activities are provided on a regular basis including Arts and Crafts, painting, poetry readings, musical entertainment and outings. Functions at the home have included a barbecue, Halloween party, Christmas party and a staff pantomime. The residents were also taken to the pantomime in Brighton and to the Ice Show, but those residents spoken with stated that they preferred the staff pantomime to both of these. The home is also to be commended on encouraging residents to follow their own interests, one gentleman having just completed the “ Bramble Eye” which is a miniature version of the “ London Eye” and propelled by the water in the pond. He is also encouraged to follow his other interests and projects in his room. A programme of activities is displayed in a prominent position in the home. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 13 Other residents spoken with stated that they can make their own choices regarding the activities of daily living and are able to have visitors as they wish. The home has an open visiting policy. Three visitors were spoken with and all spoke very positively about the home, stating that they were always made welcome and that staff were very friendly. There is a very pleasant dining room and residents can have their meals in this room or in their rooms if they prefer. Residents may also have guests for lunch. The menus are varied and residents have a choice of meals if the meal of the day is not to their liking. Records relating to resident’s choices are kept and the day’s menu displayed in the dining room. All residents are offered a gin and tonic or sherry before lunch. The cook spoken with stated she was aware of the hazard analysis schedules and had attained her food hygiene course, as has the kitchen assistant. There were adequate amounts of fresh, frozen and dried food and these were correctly stored. Records of fridge, freezer and hot food temperatures were in place and within the recommended parameters. The home was awarded the ‘Clean Food Award’ in 2005 Residents stated that they enjoyed the food and that there was a good choice offered. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 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 The home has a complaints policy and all staff have knowledge of their roles in the protection of those in their care, therefore ensuring the safety of the residents within the home. EVIDENCE: The home has a complaints procedure both on display and in the service users guide. Residents spoken with stated that they felt able to raise concerns or complaints to the manager or the provider. The CSCI has received no complaints in the past 12 months. There was evidence in the training files that the majority of staff have attended adult protection training, and staff spoken with were aware of their role in the protection of those in their care and also aware of the whistle blowing policy. The manager stated that all staff receive initial adult protection during their induction course and this is then supplemented with further training, which is updated at regular intervals. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 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): 19,20,21,22,23,24,25,26 Bramble Cottage is very well presented in décor, maintenance and cleanliness, and provides a high standard of accommodation for residents. EVIDENCE: Bramble Cottage is decorated and maintained and decorated to a very high standard, with landscaped gardens, which are accessible to all residents. The residents have a very pleasant dining room and lounge, the latter looking onto the gardens and a patio area. The home is on three floors, all of which are served by a shaft lift, and resident’s rooms are well decorated with lockable doors and a lockable facility for storing their personal belongings. Rooms have a good standard of carpeting curtains and bed linen and have been personalised with residents’ own possessions. All residents’ rooms have ensuite facilities, which include a bath. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 16 All rooms have window restrictors except for one room. A risk assessment is required for this. All first floor garden facing rooms lead onto a balcony and risk assessments have been undertaken for these. Some residents have put plants on their part of the balcony. Water temperatures to resident water outlets have been undertaken on a regular basis. However these need to show the temperature of the water in order that the manager can evidence that they are within the recommended parameters. Precautions against Legionella’s disease are undertaken. The home has no communal bathrooms but assisted bathing is provided by the use of variable height bath seats. The home is clean and free from noxious odours. Staff stated that they have had some training in infection control and records confirmed this. Staff were seen to be entering the kitchen without protective clothing and this must be addressed by the manager. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 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 The skills and numbers of staff employed are sufficient to meet the assessed needs of the residents. Personnel files must include all documentation as required by regulations 18 and 19 to ensure the protection of residents in the home. EVIDENCE: The staff rota shows that there are 3 members of staff plus the manager and an administrator during weekdays, and two waking night staff. Staff and residents confirmed that there were always sufficient staff on duty to meet the needs of the residents and residents stated that they did not have to wait for long for staff to attend to them. The home does not use agency staff, covering staff holidays and sickness with their own staff. There are a total of 30 staff employed. This includes domestic, catering, maintenance and senior care staff. All staff undertake an induction course on commencing work at the home and this meets national training organisation guidelines. Eight members of staff have attained the NVQ level 2 with a further three members awaiting their completion of this. Evidence of further staff training was shown in the training files, staff having attended medication, first aid, adult protection and mandatory training, as well as training relevant to the needs of the residents. Five personnel files were examined and whilst most contained all the documentation required by the regulations, one member of staff had been employed prior to a second written reference being received. The receipt of written references prior to employing staff is an important factor in ensuring resident safety. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 18 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): 31,32,33,36,37,38 The manager is able to fully discharge her responsibilities. The ethos in the home is good and promotes the health, safety and well being of residents. EVIDENCE: The manager, Ms D Shaw has managed Bramble Cottage since 1993. She has attained the Registered Managers Award and has attended training relevant to providing the care and leadership within the home. Residents and relatives were positive in their comments describing her as ‘the perfect manager and friend’, ‘A very efficient manager’ and that she and her deputy manager ‘are always there for the residents and for us’ (a relative). The ethos in the home is good, residents said they were happy and content and felt that the home was ‘a good place to live’. Staff turnover is low, many of the staff having worked there for a number of years. Staff spoken with said Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 19 that they thought that ‘the home is a lovely place to work’, ‘ its really nice here’, ‘I enjoy coming to work’, ‘the manager and the owners are lovely’. The home has residents meetings once a year and felt that as the home is interactive and fairly small, that this was enough. The manager stated that the residents are encouraged to make their views known, both verbally and through annual questionnaires and that residents felt that once a year was enough. Risk assessments have been done throughout the home and policies are reviewed annually. The manager should consider increasing the quality monitoring of the home over the next year, this was discussed in detail with the manager and it is suggested that this includes gaining feedback from health and social care professionals, and visitors including those people visiting the home who provide a service, such as hairdressers and ministers of religion. The quality monitoring must also include monitoring of the basic services of the home such as quality of cleaning and catering from the provider perspective. Staff receive formal supervision six times a year and partial records of these were seen. Regulation 26 visits have taken place and reports written on these. All certificates relating to the servicing of equipment and utilities were seen. The Landlords gas certificate and IEE certificate were not in the home, but the manager confirmed that these had been undertaken. All staff have received mandatory training. A window restrictor in one of the rooms was not in place and the manager must ensure that this is rectified or that risk assessment takes place. The manager must also check that the fan identified in one room is risk assessed and PAT tested, as she felt this had been newly brought into the home. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 20 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 x x 3 3 2 Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP2 Regulation Reg 5 (1)(b) Requirement That the statement of terms and conditions includes the number of the room to be occupied and a breakdown of fees showing by whom they are payable. That evidence is provided that the service user is involved in the formation of the care plan. That those drugs discussed in the main body of the report are treated as controlled drugs in line with current legislation. That prescribed medication is used only by the named service user. That staff wear protective clothing when entering the kitchen. All documentation as required by this regulation to be obtained prior to staff commencing employment. That the window restrictor identified is put in place or risk assessed and that the fan is risk assessed. Timescale for action 01/04/06 2 3 OP7 OP9 Reg 15(1) Reg 13(2) 01/04/06 03/01/06 4 5 OP26 OP29 Reg 13(3) Reg 19 03/01/06 03/01/06 6 OP38 Reg 13(4) 03/01/06 Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 22 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. 2 Refer to Standard OP2 OP26 Good Practice Recommendations That the terms and conditions identify that all service users are admitted for a months’ trial period. That the water temperatures in service user outlets are identified. Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Bramble Cottage Retirement Home DS0000014180.V273731.R01.S.doc Version 5.0 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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