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Inspection on 21/01/08 for Brandon Lodge Care Home

Also see our care home review for Brandon Lodge Care Home for more information

This inspection was carried out on 21st January 2008.

CSCI found this care home to be providing an Good service.

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

A good standard of care is provided for the people who live at the home. People said they enjoyed living there, and that the staff were kind and helpful. Comments received were in the main very positive about the care. There were written care plans in place for each person. This helps staff make sure that each person gets the support and assistance that is needed for them to live safely and comfortably. People living at the home were comfortable and well cared for and all of them said that the food was good. The environment was in the main nicely decorated and well maintained. Staff were motivated and enthusiastic about their work. The summary from the expert by experience stated "There was sufficient evidence to confirm that activities were in evidence and that residents were happy in the home. Although the cook was on his first day there was evidence to show the choice of menu available. The manager and staff were very friendly and related very well to residents. In my opinion the home was well run".

What has improved since the last inspection?

All of the people who live in the home have been provided with a statement of terms and conditions so that they know the service they can expect to receive, the amount this will cost and who is responsible for the payment. All of the bathrooms have been restored to full working order.

What the care home could do better:

Some record charts were kept on the handrails outside of bedrooms. These should be kept in individual bedrooms. The dining room was nice and bright but the paint on the serving hatch was badly worn and flaked and in need of repair. There was a strong smell of smoke in the area around the smoking lounge. An extractor fan must be fitted to ensure that this area is free from smoke. Where people have small deductions made to participate in activities, for example bingo, written evidence should be available to confirm that they have agreed to this.

CARE HOMES FOR OLDER PEOPLE Brandon Lodge Care Home Commercial Street Brandon Durham DH7 8PH Lead Inspector Sue Lowther Key Unannounced Inspection 09:30 21 & 31st January 2008 st 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 Brandon Lodge Care Home DS0000000702.V349047.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. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brandon Lodge Care Home Address Commercial Street Brandon Durham DH7 8PH 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) 0191 3781634 0191 3781636 brandon.lodge@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Mrs Anna Marie Clark Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named individual under 65 years of age in the category of PD can be accommodated 14th September 2006 Date of last inspection Brief Description of the Service: Brandon Lodge was custom built as a care home. There are 38 bedrooms, located over two floors. All bedrooms are single rooms, 37 have en-suite facilities. Brandon Lodge caters for people who require general nursing and residential care. The home is located in a semi-rural setting and is surrounded by small, well-maintained gardens. There are a variety of sitting rooms located throughout the home and a dining room is available on the ground floor. There is a varied social and recreational programme available for those who wish to participate. The fees charged at the time of this inspection were between £365 and £575 per week. The fees do not include hairdressing, toiletries and newspapers. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection was carried out on the 21st and 31st January 2008. The inspector visited the home, talked to people and read what people had written about the home. She sent out surveys to people who live in the home and their relatives to find out what they think about the home. Five people who live in the home filled in the survey forms, with the help of staff. The inspector visited the home and looked around. She met five people who live there and three care staff and the manager. She checked records and paperwork. An ‘Expert by Experience’ helped. An ‘Expert by Experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The Expert looked around the home, talked to staff and spent time with the people who live there. What the service does well: A good standard of care is provided for the people who live at the home. People said they enjoyed living there, and that the staff were kind and helpful. Comments received were in the main very positive about the care. There were written care plans in place for each person. This helps staff make sure that each person gets the support and assistance that is needed for them to live safely and comfortably. People living at the home were comfortable and well cared for and all of them said that the food was good. The environment was in the main nicely decorated and well maintained. Staff were motivated and enthusiastic about their work. The summary from the expert by experience stated “There was sufficient evidence to confirm that activities were in evidence and that residents were happy in the home. Although the cook was on his first day there was evidence to show the choice of menu available. The manager and staff were very friendly and related very well to residents. In my opinion the home was well run”. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 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 Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. The home does not provide intermediate care. Therefore assessment of standard 6 is not required. ‘People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service’. Admissions are well managed and people are provided with information about the home before moving in. EVIDENCE: The home provides a statement of purpose and service user guide, setting out its aims and objectives, the range of facilities and services it offers to people. This enables people to make fully informed choices about whether the home can meet their indivdual needs. The manager said that all of the people who live in the home have been provided with a statement of terms and conditions so that they know the service they can expect to receive, the amount this will cost and who is responsible for the payment. This was a requirement following Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 9 the last inspection. However two of the people who responded to the survey said they had not received a contract. People are only admitted after a full assessment of need is carried out by an appropriately trained person. This is usually the manager. This is to make sure that the home can meet the care needs of the people who go to live there. The family of one person who had recently gone to live in the home confirmed that they had looked around the home and had been supplied with all of the information they needed to make a decision about whether or not their relative would like to live there. All of the people who responded to the survey said that they had received enough information about the home before they went to live there. Brandon Lodge Care Home DS0000000702.V349047.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. ‘People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service’. People’s health care needs are well managed by the home. Systems to administer medication are safe and people living at the home say that they are treated well and that the standard of care is good. EVIDENCE: The manager said that all of the people who live in the home have care plans so that staff know how to look after people on an individual basis. People spoken to during the inspection said that they are happy with the care received and the level of information given. All of the people who returned the survey indicated that they are happy with the care and usually get the care that they need. Records examined showed that people receive visits from other healthcare professionals. These include district nurses, doctors, and care managers. One person who lives in the home said, “The staff know when I am not well and get Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 11 the doctor straight away. I am well looked after and all of the staff are excellent”. Medication is administered by qualified nurses. The home has a comprehensive medication policy. Accurate records of all medicines received, administered and those leaving the home are maintained. People spoken to said that staff always treat them with dignity and respect. One of the relatives said “ The staff are really good, they are lovely and speak to people nicely”. The report from the expert by experience stated “I talked to quite a few residents and five visitors/relatives and all the relatives were aware of a care plan and the nature of the placement i.e. fees and the kind of care expected. All were very complimentary about the care in the home. In walking around the home I did notice that where a resident was in bed and was being checked regularly by staff the record chart was propped up between the wall and the handrail and given that there were a few of these on view it did look rather unsightly and unprofessional”. Brandon Lodge Care Home DS0000000702.V349047.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. ‘People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service’. The home provides a range of activities with input from the people that live there. Relatives are made welcome and encouraged to visit the home. People living at the home said that they were able to make choices within all aspects of daily living. There is a varied menu and people likes and dislikes are well catered for. EVIDENCE: The home have an activities coordinator. Routines of daily living and activities are flexible and varied to suit individual expectations, preferences and capabilities. Personal choice is promoted at all times. People’s interests are recorded, there is a daily activity programme which is flexible. People can have visitors at any time and private visiting areas are available. People’s spiritual needs are respected. People are encouraged to make choices and decisions wherever possible and this was observed throughout the day. One person said “I can get up and go to bed when I want. I can also have a bath or shower when I want”. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 13 There are two choices of meal. Special dietary needs are catered for and people are assisted to eat if necessary. One person who lives in the home said “The food is excellent. We get a choice and there is definitely plenty”. The report from the expert by experience stated “I was given a full account of activities by a couple of relatives and two residents stated that the only problem was that sometimes they could not be bothered to join in but they did not mind the activity going ahead as they “got out of the way”. Staff informed me that each morning a notice is put on the wall in the dining area stating the activity for that day. I was impressed to see in the activities book that comments were made about each resident indicating whether they would have any difficulty in joining an activity e.g.; any communication difficulties. There was also a notice board on display which had photographs of residents involved in activities. Everyone I spoke to felt the meals were very good, of good quality and quantity, and with choice offered. Breakfast was fairly relaxed from 8/8.30 to 11am and residents could more or less order what they wanted (a cooked breakfast or not). The menu for the day is written in large print on a board in the dining room. The dining tables are set with a table cloth and appropriate cutlery. I was told problems can occur with some residents occasionally pulling the cloths off but it was still something staff wanted to persevere with. Afternoon refreshments were fairly substantial with tea, cake and biscuits provided. The dining room was nice and bright but I did note that the paint on the serving hatch was badly worn/flaked and in need of repair”. Brandon Lodge Care Home DS0000000702.V349047.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. ‘People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service’. Complaints and adult protection matters are supported by clear guidance and training. EVIDENCE: The home has a complaints procedure in place, which is displayed throughout the home. All of the people who returned surveys said that they would know how to make a complaint. One person said, “I have never had any problems but if I did I would ask to see the manager”. A record is kept in the home of all complaints. Those recorded since the last inspection have been investigated within the home. Two have been further investigated by social services. The manager said that improvements have been made as a result. One complaint could not be resolved within the company timescale as the complainant remains dissatisfied. This is being investigated further. Staff are trained to recognise and prevent abuse of the people who live in the home. The home has a clear adult protection procedure which links with the local authority procedure for safeguarding adults. The home also has an active whistleblowing policy. All staff spoken with said that they would have no hesitation in telling someone if there was a problem. One member of staff said “I would speak to the manager straight away. If she were not available or if it involved her I would speak to the area manager”. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 15 Recent training has taken place with regard to the Mental Capacity Act and the law, which links into Safeguarding Adults policies and procedures. Brandon Lodge Care Home DS0000000702.V349047.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. ‘People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service’. The home is in the main clean, well maintained, furnished and decorated to a good standard. EVIDENCE: The communal areas were bright and nicely decorated. However as previously mentioned, the paint on the hatch in the kitchen was noted to require repair. All of the bathrooms have been restored to full working order as required in the last inspection report. Many of the rooms are decorated to the person’s own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 17 The premises were clean and hygenic and in the main free from any odours. However there was a strong smell of smoke in the area surrounding the smoking lounge. The manager said that an extractor fan had been requested. Policies for the control of infection are in place and adequate handwashing facilities are available. The report from the expert by experience stated, “The welcome at the home was very friendly and the general appearance was clean and tidy. The home was bright and cheery, warm with a pleasant decor. At no time during my visit did I detect unpleasant incontinence smells. I also noticed that there was a smell when approaching the smoking room which could be detected from quite a distance along the corridor. There did not seem to be an extractor fan in the room which I felt was a concern particularly as residents could only smoke in the room with a member of staff present –in all that smoke!” Brandon Lodge Care Home DS0000000702.V349047.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. ‘People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service’. Staffing numbers support people’s health needs. The home has a commitment to staff training and recruitment practices protect people living in the home. EVIDENCE: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. People said that staff were usually around and answered the call bells quickly. The expert by experience stated “Call bells did ring from time to time and were responded to quickly by staff but the bell was not always turned off straight away”. The manager said that one of the complaints since the last inspection was about inadequate staffing levels. She said that these have been increased as a result. Staff spoken to confirmed this to be the case. The home had staff files in place, which provided evidence that the appointment of new members of staff is made through proper recruitment processes. This includes the vetting of staff through the use of Criminal Record Bureau (CRB) checks, Protection of Vulnerable Adult checks (POVA) and written references. Training has recently taken place in fire safety, safe handling of medicines, moving and handling and infection control. A large number of care staff are Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 19 trained to NVQ level 2. Certificates to confirm this were seen in staff files. Staff spoken to confirmed that there is plenty of training available. The report from the expert by experience stated, “In walking around the home and talking to residents I noticed that staff were always around. At times they were not aware of my presence but their contact with residents was very respectful and dignified. Similarly with relatives there was good dialogue evident with staff. I gathered that a lot of staff had worked at the home for a good period of time and relationships appeared to be good between them”. Brandon Lodge Care Home DS0000000702.V349047.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. ‘People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service’. The home is well managed and relatives and people using the service are regularly consulted about the service they receive. Financial arrangements are good and health and safety systems and practices protect people. EVIDENCE: The manager is a qualified nurse and has several years experience in working with older people. Staff, the people who live in the home and visitors were extremely complimentary about the manager. One member of staff said “The manager is very approachable and I would not hesitate to approach her if I had a problem”. A relative said “The manager has been very supportive to me and my family. My relative is very happy here”. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 21 There are clear lines of accountability within the home. Staff, relatives and those living at the home are actively involved in the decision making process of the home. The home has an annual plan for quality assurance which includes meetings staff. These are held monthly and information from these are included in quality monitoring. Relatives and the people who live in the home can approach the manager at any time as she operates an open door policy. The area manager completes a regulation 26 visit monthly. This is an audit which covers all aspects of the environment and the care delivered. The manager said that during this audit the area manager speaks to staff, the people who live in the home and visitors about their views. Any suggestions made are considered and improvements made where possible. Personal finances are kept in the home for people who request this. Two signatures are obtained and receipts are kept to ensure peoples’ financial interests are safeguarded. However where people have small deductions made to participate in activities, for example bingo, written evidence should be available to confirm that they have agreed to this. Health and safety systems were looked at. Safe working practices are maintained in line with current regulations and appropriate risk assessments are available. All safety checks for maintenance are carried out by external contractors as designated by law. All accidents are recorded and reported appropriately. Brandon Lodge Care Home DS0000000702.V349047.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 X 3 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 X 3 X X X X 2 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 X 3 X 3 X X 3 Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 23 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 OP26 Regulation 23(2)(p) Requirement An extractor fan must be fitted to the smoking lounge to ensure that the surrounding area is free from smoke. Timescale for action 30/04/08 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. 3. Refer to Standard OP19 OP19 OP35 Good Practice Recommendations Record charts should be kept in individual bedrooms and not on corridor handrails. The worn paint on the kitchen hatch requires repair. Written evidence should be available to confirm people have agreed to deductions being made from their personal allowance for them to participate in activities. Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Brandon Lodge Care Home DS0000000702.V349047.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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