Inspection on 11/10/07 for Dalmuir Home

This inspection was carried out on 11th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Dalmuir Home 01/02/07

Dalmuir Home 24/10/05

Dalmuir Home 18/05/05

Dalmuir Home 30/09/04

Dalmuir Home 05/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Dalmuir Home 25 Gresham Road Limpsfield Oxted Surrey RH8 0BU Lead Inspector Lesley Garrett Unannounced Inspection 11th October 2007 10:30 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 Dalmuir Home DS0000013621.V346501.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. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dalmuir Home Address 25 Gresham Road Limpsfield Oxted Surrey RH8 0BU 01883 715630 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) mikenoorbaccus@btinternet.com Mr Mike Noorbaccus Mrs Myrna Noorbaccus Mr Mike Noorbaccus Mrs Myrna Noorbaccus Care Home 16 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (11), Learning disability over 65 years of age of places (2), Old age, not falling within any other category (16) Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Of the 16 older persons (OP) accommodated, up to 12 persons may fall within the category DE(E) The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE Of the 16 older people accommodated, 1 (one) may be in the category LD(E), learning disability and 1 (one) may be in the category LD(DE) and over 60 years of age. Of the people accommodated with dementia 1 may be under 65 4. Date of last inspection 1st February 2007 Brief Description of the Service: Dalmuir Home is registered with the Commission for Social Care Inspection to provide accommodation and care to sixteen residents under the category of older people. The home is located in a residential area close to public amenities and other facilities. Accommodation is on three floors accessed by lift or stairs and comprises of an office, lounge, dining room, kitchen, laundry area, bathrooms, toilets and single and shared bedrooms some of which have en-suite facilities. The home has a garden, which is private and secure with wheelchair access and parking is available. The range of fees charged by the home is £575.00 to £640.00 per week. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. The registered manager and deputy represented the service. For the purpose of the report the individuals using the service are referred to as people/residents. The inspector arrived at the service at 10.30 and was in the home for four and a quarter hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the homes manager, and any information that CSCI has received about the service since the last inspection. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff recruitment profiles, staff training records, and health and safety records. The home has submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, some details of which have been added to the report. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The inspector would like to thank the people living in the home and the staff for their time, assistance and hospitality during this inspection. What the service does well: The manager and deputy visit every resident prior to admission to the home to ensure that they can meet the assessed needs of that individual. Care plans are generated from this assessment and a further review is carried out on admission to ensure the health care needs have not changed. Activities are organised to suit each individual resident and they have a choice on whether they participate or not. Comments received on the day were complimentary about the food that is available at the home and all residents are given support with their meals if they require it. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 6 From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. 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. Dalmuir Home DS0000013621.V346501.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 Dalmuir Home DS0000013621.V346501.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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people who use the service have a pre-admission assessment and are confident that their needs will be met. The home does not provide intermediate care beds. EVIDENCE: The manager and deputy both confirmed that they carry out all pre-admission assessments together. They have an assessment tool which is used and that was observed for the two individual plans of care that were sampled. The manager stated that following admission another assessment is then completed to make sure that there have been no changes to the individual’s health care needs. All care plans are then generated from these assessments. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 9 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have individual plans, which reflect the care and support they require and their health care needs are fully met. The medication policies and procedures that are in place and implemented by staff protect the residents. The privacy and dignity of the individuals is respected. EVIDENCE: The deputy manager stated that the home uses an electronic care planning system and two individual plans were sampled. The plans contained risk assessments and individual plans for personal care. The manager stated that the home has only been using this system since the beginning of the year and is still developing their practice. A discussion took place with the manager and the deputy and a recommendation made that the plans could be expanded to contain more detailed information to allow the reader more information about the care needs of people who use the service. Following the inspection in February this Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 10 year a requirement was made to review all the plans monthly and it was observed that this has now been actioned. Further discussions took place with the manager and deputy about nutritional risk assessments. They stated that this was not a risk assessment that the home was incorporating into their care plans. A recommendation has been made that the home does complete a nutritional risk assessment for all people who use the service. All individuals are weighed monthly and staff observe their dietary intake. On the day of the site visit one visitor stated ‘the staff are very caring and look after them very well’. Another comment received stated ‘the residents always look well cared for’. One individual stated ‘I’ve just had my hair done I go to the hairdresser every week’. The manager said that all people who use the service are registered with a local general practitioner (G.P.) who will visit the home when needed or individuals can visit the surgery. The home also has the support of the district nurse and community psychiatric nurse, opticians, chiropodist, dentist and psychiatrist. The manager stated that the district nurse keeps their own records but all visits are documented on each individuals care plan. On the day of the site visit the nurse was visiting some residents for a routine check. The home has a medication policy and staff receive medication training in order to safeguard the welfare of the people who use the service. A review of records confirmed the home had the support of a local chemist to supply medications to the home and kept a record of medications received by and disposed of to prevent mishandling of medications. A recommendation has been made that the medication administration records contain a front sheet, which has a photograph of the individual and details about them for example any allergies. The home has a policy regarding privacy and dignity and this subject is discussed during the induction for all new staff. It was observed that staff knocked on the bedroom doors before entering and screens were available for shared rooms. The care plans contained the details of the preferred name for each person who lives at the home. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 11 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to exercise choice and control in all that they do and the food is of a good quality. EVIDENCE: The manager and deputy stated that the home employs an activity coordinator and the programme of activities was displayed in the hall. All people who use the service have an activity chart in their individual care plans. A requirement was made at the last inspection for the activity programme to be in a format that can be understood by the people who use the service. The deputy has made laminated cards which shows the activity for that day and this is put on the notice board. The deputy stated that they have an activity every day but this is not always a large group activity. On the day of the inspection the hairdresser was in the home and individuals were noticed to be sitting and talking with members of staff, one lady was busy doing crossword puzzles, visitors were in the home and the hairdresser was busy talking to individuals whilst they were having their hair done. One visitor stated that he visited every day to sit and talk to his friend. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 12 The deputy stated that there is a church service every two weeks and one individual visits the local church every Sunday. It was also stated that for the past twenty years visitors from the church visit the home and they help with parties and functions and will also sit and play board games with those that wish to participate. The home benefits from the use of their own mini bus so trips out can be arranged. The deputy stated that they do not go too far these days due to the increasing frailty of the people who use the service. The most recent afternoon out was a picnic in the summer, which was enjoyed. The deputy manager stated the home promoted choice and people who use the service were able to bring personal possessions to the home. The deputy said that they are always asked what they would like to wear in the morning and they can also choose when to get up and go to bed. On the day of the site visit the chef stated that individuals have a choice of meals including breakfast. A cooked breakfast is available if anyone would like this and the main meal of the day is lunch. Tea and homemade cakes are served in the afternoon with supper being a lighter meal with soup always available. The dining room was laid ready for lunch and the deputy stated that a member of staff sits at the table to have their lunch and is then available to assist with the meal if they are needed. People who use the service that were spoken to remarked that they enjoyed the food. One stated ‘the portions are sometimes too big and I have to leave some’. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 13 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service are protected by the homes complaints policies and safeguarding procedures. EVIDENCE: The home has a complaints policy and this was observed. The complaints procedure is available to all people who use the service and a copy given to their relatives or representatives. The deputy keeps a complaints log but stated that the home has not received any complaints since the last inspection. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The deputy stated that she carries out the safeguarding training within the home. A discussion took place around safeguarding, as the senior members of staff within the home have not had the local authorities safeguarding training for at least two years. The manager stated he would organise this as a matter of urgency for himself and the two deputies. Since the inspection the deputy has informed CSCI that the manager has now arranged a workshop for the staff to be which will be held at the home. The safeguarding training for the rest of the staff is in the form of a questionnaire that is provided along with a DVD from a training company. The questions that were asked were about incidence and types of abuse. The Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 14 manager and deputy both said that once they had been on the local authorities training they would cascade this information to all staff. The manager and deputy said that the training that was currently being delivered to the staff was in line with the local authority. Dalmuir Home DS0000013621.V346501.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a well-maintained environment, which was clean and hygienic. EVIDENCE: On the day of inspection it was noted that the home is undergoing a redecoration programme. The manager said that to minimise disruption to the people who use the service the decorators are doing the communal areas at night. The manager also said that the plan was for the decorating to be finished by Christmas. All rooms have been personalised to reflect the personality and preferences of the individual. There are no en-suite bathrooms on the upper floor but there are adequate bathroom facilities for the number of residents. A discussion took place with the manager who stated that there are no plans to refurbish the bathrooms this financial year. A recommendation has been made that the Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 16 manager look at the provision and decoration of bathrooms to ensure that they meet the changing care needs of the people who use the service. The cupboards in the bathrooms have no doors on them leaving some cleaning materials accessible to the people who use the service. The manager stated he would put the doors back on that week therefore no recommendation has been made. The home was clean and it was noted that there was sufficient hand washing facilities for use by the staff. The laundry room is used for the washing and adjacent to this room is where all the clean washing is stored prior to it being taken back to the individual bedrooms. The floor in the laundry room is worn and the sink was very dirty. A recommendation has been made at the end of the report for this area to be cleaned and for the floor to be looked at and assessed with a view to replacing if necessary. Dalmuir Home DS0000013621.V346501.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of people who use the service. EVIDENCE: The deputy said that she completed all the staff rotas, which ensures that there is a good skill mix. The deputy also stated that the manager completes dependency levels every month to ensure there are the correct number of staff for the people who use the service. The inspector observed the rotas and the numbers appeared consistent. Staff told the inspector that the night staff are waking and will assist with the morning routine of washing and dressing if the residents are awake and requesting that they get up. The deputy stated that 50 of their staff had the National Vocational Qualification (NVQ) and that further staff has just been enrolled to do this qualification. The deputy stated that new staff recently recruited would not be enrolled as they are currently attending English lessons to improve their communication skills first. Two recruitment folders were sampled for the two newest recruits to the home. The manager stated that all recent recruits have been employed through a specialist agency and they had carried out all the pre-recruitment checks. The Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 18 manger did say that criminal record bureau (CRB) checks are undertaken by the home when they are employed. It is a recommendation at the end of the report for the home to ensure that new employees from the agency also complete the homes application form for their records. The manager and deputy said that they employ outside trainers to come to the home to deliver the training needs of the staff. The home has also purchased a variety of learning materials including DVD’s, booklets and questionnaires for the deputy to deliver training also. The home has a training plan, which the manager showed to the inspector, and this included the mandatory training, which included safeguarding adults, fire, first aid and food hygiene. The staff had just completed their manual handling and the records were shown to the inspector. Dalmuir Home DS0000013621.V346501.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness, has effective quality assurance systems developed by a qualified competent manager. EVIDENCE: On the day of the inspection the inspector met with both the registered manager and deputy. The manager has been registered with the Commission for a number of years and also has the registered managers award (RMA). The manager told the inspector that the deputy who also has the RMA undertakes day-to-day management of the home. Staff spoken with was clear about the lines of management responsibility within the home. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 20 The deputy told the inspector that quality audit forms had been completed within the home about specific services. This was discussed with the manager and deputy and there will be a recommendation at the end of the report for the home to develop a quality audit system that included the relatives and other stakeholders within the home. On completion of the audit process an action plan can be drawn up to identify areas for improvement. The manager stated that no personal money is kept at the home. The home will pay for anything that is required and will then invoice every month. All receipts and invoices are kept and the hairdresser confirmed this method of accounting during the inspection. The home had supplied an AQAA to the Commission to assist with this inspection and it was observed that the home currently has certificates in place for the fire equipment, heating system and hoists. During a tour of the building it was observed that all of the radiators are uncovered but the manager stated that they all had thermostatic valves in place and the maintenance person regularly checks the temperature to ensure the surface temperature does not become too hot. It is a requirement that the home develops risk assessments for the radiators that are not covered to ensure the safety of the people using the service. Dalmuir Home DS0000013621.V346501.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 X 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 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 22 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 OP38 Regulation 13(4)(a) Requirement All radiators within the home that do not have covers should have risk assessments in place to ensure that all parts of the home that residents have access to are free from avoidable risks. Timescale for action 11/11/07 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 OP7 Good Practice Recommendations It is recommended that the care plans should be expanded to include more information about each resident’s care needs. It is recommended that a nutritional screening tool be incorporated into the care plans. It is recommended that all medication administration records contain a front sheet, which includes a photograph of the resident, and any other medical details for example allergies. It is recommended that when the current refurbishment of the home is complete the manager give consideration to the updating of the bathrooms to ensure they meet the DS0000013621.V346501.R01.S.doc Version 5.2 Page 23 OP8 OP9 4 OP21 Dalmuir Home 5 6 7 OP26 OP29 OP33 needs of the people who use the service. It is recommended that the sink in the laundry is kept clean at all times and that the floor is assessed as the paint has worn away. It is recommended that all staff that have been recruited through a specialist agency also complete the homes application form. It is recommended that the home further develop the quality monitoring system to include seeking the views of relatives, friends, volunteers and other visiting professionals. Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Dalmuir Home DS0000013621.V346501.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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