Inspection on 10/10/06 for Elmhurst

This inspection was carried out on 10th October 2006.

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

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

Other inspections for this house

Elmhurst 08/11/05

Elmhurst 16/06/05

Elmhurst 09/12/04

Elmhurst 30/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Elmhurst 69 Pollard Lane Bradford West Yorkhsire BD2 4RW Lead Inspector Sue Dunn Key Unannounced Inspection 10th October 2006 12:00p 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 DS0000001241.V312697.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. DS0000001241.V312697.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmhurst Address 69 Pollard Lane Bradford West Yorkhsire BD2 4RW 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) 01274 638151 01274 634890 N/A R & N Partners Mrs Deborah Fitzmaurice Care Home 22 Category(ies) of Past or present alcohol dependence (1), registration, with number Dementia - over 65 years of age (7), Old age, of places not falling within any other category (15), Physical disability (2), Physical disability over 65 years of age (7) DS0000001241.V312697.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2005 Brief Description of the Service: Elmhurst is a pair of stone built semi detached Victorian style family houses converted to provide residential accommodation for 22 older people. Changes in legislation concerning multi occupied rooms and minimum space requirements have led to a reduction of occupancy. The home currently has 10 single and 5 double rooms. Only one room, a single, has en-suite facilities. Accommodation is on three floors with access to the first floor by stair lift. The laundry and office are situated in the basement. A small neatly kept garden to the front of the house overlooks the road and offers a sitting area for clients. A conservatory to the rear of the building is used as the designated smoking area. There is no ramped access to the house and parking is on the road. The home is situated in the Bowling area of Bradford within walking distance of local shops, a park and a golf course. The home is one of two in the Bradford area owned by the same proprietors and employing family members. The two homes work closely together and the proprietors take an active interest in the day-to-day activities of the homes. DS0000001241.V312697.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection, which was announced, was undertaken by one inspector. The inspection started at 12.00pm and finished at 6.00pm. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents. A completed pre inspection questionnaire had been completed and returned by the manager and was used to provide evidence to support judgements throughout the report. One service users comment questionnaire had been returned at the time of writing and gave a positive view of the home. The inspector spoke to residents, relatives, staff, and the manager of the organisation’s other home in the city. Records were inspected, including resident’s care plans and daily occurrence sheets, staff training and safety check records. A brief inspection of all parts of the building was carried out. The weekly fee for care is £354.76. Hairdressing, chiropody, personal toiletries and clothing are not included in the fees. The home makes an extra charge towards the cost of providing a member of staff for hospital escort duties. What the service does well: What has improved since the last inspection? DS0000001241.V312697.R01.S.doc Version 5.2 Page 6 The recording of pre admission assessments had improved with the addition of a section to record background history to assist staff to make care more personalised. The guidance in the care plan of a person whose needs had increased was detailed and covered all areas of care. The information in daily records allowed care to be tracked from day to day. The home has introduced a pressure grading risk assessment approved by the local health trust as this is felt to be more suitable for care homes than the risk assessments previously used. Staff are taught the basics of adult protection and dementia care as part of their induction training. More in depth training has been booked as places on courses become available. Communal areas and some bedrooms had been redecorated and some windows replaced. Recruitment records had improved with the introduction of a fuller record of the candidate’s past employment. Some attempt had been made to record the notes of interviews. What they could do better: All documentation must be dated. There should be a record of assessment carried out before a person is readmitted to the home from hospital to show why the decision has been made not to re admit anyone whose needs cannot be met. All the factual information about each person should be recorded where it could be accessed instantly without having to read through the whole file. Some of the information in daily records would be better placed in a care plan to avoid the risk it may be overlooked as time passes. There was a lack of continuity in some information which made it difficult to establish what decisions had been made, when and by whom, particularly for people who were originally admitted to the home on a short stay basis. All accidents/incidents must be recorded appropriately and the CSCI informed about anything which may affect the well being of service users. The following health and safety issues require attention: The hold open device on the fire door into the kitchen must be repaired, The laundry floor must be made impervious and the laundry area redecorated and included in the routine cleaning schedule. A bin with a lid must be provided for the soiled waste in the downstairs toilet and all areas of the home kept free from unpleasant odours. Toilet rolls and suitable hand washing and drying facilities must be provided in all bathrooms and toilets at all times. Paintwork in those areas not used by residents must be cleaned to the same standard as elsewhere in the home. DS0000001241.V312697.R01.S.doc Version 5.2 Page 7 The recruitment process could be improved further by keeping more detailed records of the interview and ensuring two written references are obtained which are relevant and of a satisfactory standard. 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. DS0000001241.V312697.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000001241.V312697.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 (6 N/A) The quality outcome in this area was good. The judgement is based on all the available evidence, which included discussion with staff and inspection of documentation. There was evidence to show that the home had a system of assessing needs before admitting people and encouraged pre visits. Initially the assessments appeared basic and were undated but were backed up by more information which was recorded in the daily notes. EVIDENCE: A standard format was used for pre admission assessments and included an additional sheet for some personal history to assist the staff to provide a more personalised approach care. The assessments inspected were undated but daily records indicated the assessments had been done before admission. Where one person had chosen not to speak of her past life this had been recorded and accounted for what was a very basic assessment of needs. The daily record in one file recorded that the person had been able to make a decision about the home by visiting and staying for a meal beforehand. DS0000001241.V312697.R01.S.doc Version 5.2 Page 10 Notes in one file stated the home could meet the needs of a person re admitted to the home from hospital though there was no evidence of a formal reassessment of needs. Staff had been visiting her in hospital and had been able to monitor her progress but there was nothing on record. DS0000001241.V312697.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality outcomes in this area were good. This judgement was based on all the available evidence, which included inspection of care files, discussion with service users, staff and visitors and observation. Most of the information regarding care needs and how these were met was to be found in the care plans or daily notes of the files examined. Some of the detail in daily notes would be better shown as the action to be taken in the care plan to avoid the risk of the information being overlooked. Care plans should describe how emotional, spiritual, and recreational needs are to be met. Service users and their representatives were happy with the care they received. EVIDENCE: Four care files were inspected. One was case tracked. Each file had a front sheet for factual information. However the files with more recently introduced forms did not contain all the factual information, which made it difficult for a member of staff to find the nationality of one person without searching through the whole file. DS0000001241.V312697.R01.S.doc Version 5.2 Page 12 The amount of information in care plans in each of the files seen varied. What was missing from the care plans however was found in the daily notes. This information will become difficult to find in the files as more information is added and then archived unless the care plans allow for cross-reference to the daily records. A person admitted from hospital for a short stay for the purpose of recuperation was still in the home several months later. The assessment stated that physiotherapy was to be provided but none of the later documentation recorded if this had taken place. There was a record of discussions about a change of room but nothing found in the documentation to say why and who had been involved in the decision for her to remain in the home or if this was to be permanent. This same person had two plans of care, one for mobility and one to reduce the risk of falls. Care plans for social recreational and emotional needs had not been documented but information about this could be found by reading through the personal history and daily records. A Waterlow pressure sore risk assessment had been completed the day before admission, and a moving and handling assessment with the care plan was done on day of admission. Another file included a Maelor pressure grading risk assessment, which has recently been introduced by the local care trust as an effective way of assessing the risk of pressure ulcers. Detailed daily records showed how the home provided care and involved advocates, families and friends. Care plans in another file had been amended as needs changed and information recorded on each day could be tracked on subsequent days. Accident records had not been completed for three falls recorded in one of the files. The CSCI had not been notified about an accident involving referral to hospital as required by the care home regulations. The manager had been on a course on death and dying since the last inspection. DS0000001241.V312697.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement was based on all the available evidence, which included, discussion with staff, inspection of care files, conversation with service users and relatives and observation. There is a formal and informal range of activities. This suits the people currently living in the home and provides opportunity for them to maintain contact with the local community if they wish to do so. The menu met the nutritional needs and tastes of the people spoken with and was flexible to the needs of individuals. EVIDENCE: One of the service users brought her dog into the home. This continues to be a source of interest and conversation for all the service users. The dog is taken for walks round the block by staff, sometimes accompanied by a resident. More mobile service users go out to the local shop. Others can go out with relatives or may be taken out by the manager or staff. There is the opportunity to attend bingo at the local church hall but the current group of service users choose not to do so. People were seen to be able to use their rooms during the day if they did not wish to sit in the main lounges. One person said a singer had provided entertainment on the day before the inspection visit. DS0000001241.V312697.R01.S.doc Version 5.2 Page 14 There was evidence of magazines and reading material around the home brought in by staff and families. The people spoken with were satisfied with the food, which was described as ‘good’ Nutritional assessments were seen on file and daily records showed the efforts made by staff to encourage people to eat. DS0000001241.V312697.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area was good. The judgement is based on all the available evidence, which included information from the pre inspection questionnaire, discussion with staff, a visitor and inspection of records. The home has made efforts to give people the information they require for the protection of service users whilst awaiting the formal training. The manager was described as approachable if anyone felt they had any concerns therefore grumbles did not develop into complaints. EVIDENCE: The pre inspection questionnaire stated there had been no complaints. A visitor to the home said she had not had a copy of the complaints procedures but felt confident about going to the manager if there were any problems. She stated the manager ‘could not do enough’ to ensure life was made comfortable for residents. A member of staff spoken with stated she had received the booklet on adult abuse as part of her induction training. A completed adult protection booklet was seen in another staff file. There was evidence in daily records to show how the home had dealt with an adult protection issue. The CSCI had not received any notification of this. Three staff, including the manager, were on a standby list waiting for a place on the local authorities adult protection-training course. DS0000001241.V312697.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this area was adequate. This judgement was based on all the available evidence, which included information from the pre inspection questionnaire, discussion with staff and service users, and a tour of the premises. The home has a steady programme of redecoration and refurbishment and retains its ‘homely’ comfortable atmosphere. More attention must be given to hygiene and measures to reduce the risk of cross infection. The repair to fire door into the kitchen must be given high priority. EVIDENCE: The home has an ongoing programme of refurbishment and re decoration. Since the last inspection visit the corridors and some bedrooms had been redecorated, some of the windows had been replaced with double glazed UPVC, and new vertical blinds had been fitted to upstairs windows. Visitors to the home and service users themselves commented on the cleanliness of the home but some of the paintwork in areas not used by service users needed cleaning. DS0000001241.V312697.R01.S.doc Version 5.2 Page 17 A slight odour was noticed at the end of the corridor on the first floor and there was an unpleasant odour in the downstairs toilet due to an un-lidded bin containing incontinence pads. Some of the upstairs toilet cubicles did not have toilet rolls and there were no hand drying facilities as one towel dispenser was empty and the paper hand towels in the bathroom could not be removed from dispenser. The home, which was an existing registration, has fewer bathrooms than the ratio of 1:8. Service users clothing and bedding appeared well laundered. The laundry, which is in the cellar, was not up to the standards seen elsewhere in the home. There was a build up of dust and debris, which included a soiled dressing on the floor and around the machines creating a potential source of cross contamination. (The staff cleaned the area as soon as it was pointed out). The floor needed re sealing to make it impervious and the area redecorated and included in the cleaning schedule to make it a more hygienic and pleasanter place to work. The kitchen door hold-open device was said to be broken and awaiting repair. The door was being wedged open whilst lunch was being served. Action must be taken to ensure this is repaired as soon as possible in the interests of fire safety. DS0000001241.V312697.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality outcomes in this area were good. This judgement was based on all the available evidence, which included discussion with staff, service users and visitors to the home, observation and inspection of records. The staff were able to discuss the training they had received and were observed to put their learning into practice. Service users and their visitors spoke highly of the staff and the care they received. There had been an improvement in the recruitment and selection records. This would be improved further by including more details about the interview and insistence on more detail in references. EVIDENCE: Staffing levels were satisfactory for the levels of need of the 20 residents. There is a total of fifteen care staff. Six had achieved the NVQ award and one more had signed up for NVQ. It was said that three staff felt they were too old to do NVQ. Service users said the staff were ’very nice’ and a friend of a service user said the staff were ‘good and kind’. She had observed when people didn’t know she was there and said they were ‘consistent in their approach’. A care worker described the induction training she received which included informative booklets explaining the basics of adult protection, dementia and challenging behaviour. DS0000001241.V312697.R01.S.doc Version 5.2 Page 19 She had just completed moving and handling training from the organisation’s trainer. Dementia training was booked for the end of October. The recruitment files for three employees were inspected. The application form had an attached sheet for candidates to record the last 10 years of their employment history. Brief notes gave some indication of the interview process. There was evidence to show that Criminal Record Bureau checks had been undertaken with a record held of the dates and serial numbers. There was only one reference for one person and very basic references for another, which gave little information. If there is a reason why two written references cannot be obtained this should be recorded, as should details of a verbal reference. DS0000001241.V312697.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality outcomes in this area are good. This judgement was based on all the available evidence, which included information from the pre inspection questionnaire, discussion with staff, service users and their friend/relatives, observation and inspection of records. The manager of the home adapts her approach to the varying needs and wishes of people who live in the home. Staff receive formal supervision and are able to use their initiative in her absence. Some shortfalls were noted in systems to control the risk of cross infection and fire safety. EVIDENCE: The manager was off duty on the day of the inspection visit. Staff were clear about who was the senior care worker in charge of the shift. She assisted the inspector until the manager of the organisation’s other home in the city arrived. DS0000001241.V312697.R01.S.doc Version 5.2 Page 21 The manager keeps up to date with her own training needs and had recently completed a course on Death and Dying. A visitor spoke highly of manager’s approachability and assistance saying ‘she can’t do enough for the residents’. The home manages the money for one person at his request. This is held securely and can be accessed on request. There was evidence to show that staff received formal supervision. The staff appeared confident and were carrying out their tasks in a relaxed and efficient manner. The pre inspection questionnaire gave dates when the health and safety checks had been carried out. These were up to date. Concerns about odour control and cross infection have been included in the environment section of the report. DS0000001241.V312697.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 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 2 3 3 3 3 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 3 3 x 3 3 2 2 DS0000001241.V312697.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 OP7 Regulation 15 Requirement All documentation must be dated and the full range of care needs laid out in a plan of care which provides staff with guidance on how to be consistent in meeting those needs. A record must be kept of all accidents/incidents. And the CSCI must be notified of any events which affect the well being of service users. There must be suitable hand washing and drying facilities in the toilet and bathroom areas at all times and soiled waste bins must be covered as discussed. The laundry must be maintained in a condition which reduces the risk of cross infection. Satisfactory level of odour control must be maintained in all areas of the home. The CSCI must be notified of the occurrence of any event which affects the well being of a service user. DS0000001241.V312697.R01.S.doc Timescale for action 31/03/07 2 OP8 OP37 17 schedule 4 30/11/06 3 OP21 OP26 16 30/11/06 4 OP26 16 31/03/07 5 OP31 OP37 37 30/11/06 Version 5.2 Page 24 6 OP38 23 The hold open device on the kitchen door must be repaired to ensure the door closes in the event of fire. 30/11/06 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 OP4 OP7 Good Practice Recommendations There should be a written record of assessment for people who are re-admitted to the home from hospital to ensure the home can continue to meet their needs. All factual information in care files should be recorded in a place where it can be easily accessed DS0000001241.V312697.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 DS0000001241.V312697.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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