Inspection on 12/06/07 for Granby Court

This inspection was carried out on 12th June 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

Granby Court 26/01/06

Granby Court 04/10/05

Granby Court 15/09/04

Granby Court 16/04/04

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

CARE HOMES FOR OLDER PEOPLE Granby Court Granby Road Harrogate North Yorkshire HG1 4SR Lead Inspector Jo Bell Key Unannounced Inspection 12th June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000007805.V333676.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. DS0000007805.V333676.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granby Court Address Granby Road Harrogate North Yorkshire HG1 4SR 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) 01423 505511 01423 531002 granby.court.m@fshc.co.uk Granby Care Limited Mrs Nicola Wilkins Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places DS0000007805.V333676.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: Granby Court is part of a converted and extended large hotel set facing a green park on the outskirts of Harrogate Old Town. It was opened as a home in 1995 and the original conversion was to a very high standard with a good range of facilities. It currently is registered for 48 older people and their accommodation is on three floors served by a shaft lift. The fees per week are £700-750, additional charges are made for hairdressing and chiropody. DS0000007805.V333676.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of the service took place on Tuesday 12th June 2007. Prior to the site visit a pre-inspection questionnaire was completed. Eighteen surveys from relatives and a further eighteen from people using the service were returned to the Commission for Social Care Inspection (CSCI), along with four comment cards from doctors. One inspector spent seven hours at the home during which time a range of people including staff, relatives, healthcare professionals and people living in the home were spoken with. Throughout the day observations of care practices took place, the lunchtime meal was observed, discussions with the management and inspection of documentation took place regarding to health and safety and the environment. Overall the service provides a high standard of care in a beautifully decorated environment. What the service does well: What has improved since the last inspection? The high standard, which people living in the service expect, continue to be maintained in most areas. As Four Seasons Healthcare now owns the home, staff are in the process of implementing some new systems of working, and in the recording of information. DS0000007805.V333676.R01.S.doc Version 5.2 Page 6 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. DS0000007805.V333676.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 DS0000007805.V333676.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 (Standard 6 is not applicable) People who use the service experience excellent quality outcomes in this area. Individual needs are assessed in a detailed and effective manner. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People have their needs assessed by the manager or deputy of the home. Three pre-admission assessments were checked and these contained a range of information relating to personal and social care. People discussed the assessments that had taken place, and confirmed that someone from the home had asked them questions and identified their needs. The manager had a good understanding of the client group, and was clear about the level of needs that staff could effectively meet. DS0000007805.V333676.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 People who use the service experience good quality outcomes in this area. The standard of health and personal care provided is high, though some aspects of medication and documentation need to be improved. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home provides a high standard of care, this was evident through observations of people in the communal areas and in their own bedrooms. Discussions by individuals, and comments received in surveys returned to CSCI also confirmed the high standard of care received. People looked extremely well cared for, clothes were clean and ironed, nails were manicured, glasses were clean and people had visited the hairdresser and looked smart and comfortable. Visits from the doctor, chiropodist, and community nurses were evident through discussions and this was also recorded in individual care plans. The manager is aware of how to report accidents and incidents through the Regulation 37 notification form. One healthcare professional said ‘this home is excellent’. Another person said ‘it is just lovely here, staff are so attentive’. Three people were spoken with in detail and their care plans, medication and DS0000007805.V333676.R01.S.doc Version 5.2 Page 10 environment was inspected. Whilst staff were aware of how to meet needs these were not consistently documented in the care plans. The new deputy has worked hard giving staff training in the new paperwork which has recently changed, though this area needs to be reviewed. Care plans inspected had very general information in which did not reflect individual needs. One person who was at risk of developing a pressure sore had a plan stating ‘apply creams to pressure areas when needed’, and ‘ensure all pressure relieving aids are in place’. It was unclear if a mattress or cushion was in use or what creams were being applied. On another occasion a plan was in place regarding medication needed when a person experiences pain. The expected outcome was not to relieve the pain but to administer the medication. This does not explain what the outcome for the person should be. Some weights had not been recorded for 3 months, staff need to be clear about the rationale for weighing people monthly. A range of risk assessments were in place for nutrition, moving and handling, prevention of falls and prevention of pressure sores. Care plans had been reviewed and evaluated and audits take place on a regular basis. It was evident throughout the visit that people were treated with the utmost respect, privacy and dignity was maintained and everyone observed was spoken to in a kind and caring manner. Staff were observed knocking on bedroom doors prior to entering, and care was given away from the communal areas in the privacy of an individuals room. People were observed having medication administered by staff who had undertaken medication training. The deputy is a registered nurse and is aware of how to administer and dispose of medication. Currently a medication round takes place during lunchtime, this would be more appropriate when people weren’t eating and drinking (though it may be some medication needs to be given with food). Some people in the home deal with their own medication. One person spoken with confirmed she takes her own tablets and has responsibility for these. Staff check to confirm this has happened. Policies are in place for both self-medicating and staff administering medication. Controlled drugs are stored and recorded correctly and fridge temperatures are taken daily. Staff need to be clear about the storage of eye drops, currently these are stored in the fridge and not all of them have to be. This was checked with a pharmacist to confirm this. A medication audit takes place which includes the question ‘are eye drops stored correctly’ this has consistently been ticked but is incorrect. An audit of one persons medication had been taken a day ago, the related medication chart was checked and this contained an error regarding stock balance of a liquid medication, the dose read 100mls and it should have read 1000mls. Details regarding stock needs to be part of the audit check. On some medication charts the medication had been hand written by a member of staff instead of being printed by the chemist, this was not always signed by the person who wrote it. On one occasion olive oil had been DS0000007805.V333676.R01.S.doc Version 5.2 Page 11 administered without been included in the ‘homely remedies’ and the contents of the bottle inspected had expired six months ago. This needs to be reviewed. DS0000007805.V333676.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 & 15 People who use the service experience excellent quality outcomes in this area. A range of activities are available where autonomy and choice is encouraged, and the meals provided are of a very high standard. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People using the service have access to a range of activities which are facilitated by a competent activities organiser. Music, newspapers, television and radio are all accessible and trips into Harrogate, entertainers, quizzes and one to one sessions take place on a regular basis. The activities organiser keeps a record of activities which have taken place and on inspection these were varied and suitable for this client group. Some people said they enjoy going to the hairdressers or sitting with a book whilst drinking a glass of wine from the bar. People are encouraged to participate in activities, though this is optional. People spoken with confirmed they could get up and go to bed when they want and decide on their daily routine. Religious needs are taken into account, and a range of places to worship are available in the area. Holy communion is offered on a monthly basis, which was advertised on the notice board. Each day is very much centred around the people using the service and staff are aware that each individual has different needs. DS0000007805.V333676.R01.S.doc Version 5.2 Page 13 The lunchtime meal was inspected and observed and a discussion with the chef took place. A three course meal is available at lunchtime and staff ask people to complete a menu the previous day. Two main courses are available and alternatives are always offered if someone prefers something different. The dining area was extremely pleasant with tables available either for one, two or four people. The style is similar to a restaurant and staff come and serve people and offer a range of vegetables with the main course. The dining room is decorated to a high standard and suitable chairs, tables and crockery were evident. The portion sizes are good and assistance is given in a dignified manner when needed. Most food is home made, with fresh vegetables and homemade desserts on offer. In discussions with the chef it was evident he is aware of how to fortify food if a person is underweight, and how to ensure soft or pureed food is presented in an appetising and appealing manner. Food hygiene training has been completed by staff, and people’s views and opinions regarding the food is sought by the care and catering staff. One person said ‘the food is beautiful’ another said ‘its just wonderful’. DS0000007805.V333676.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 & 18 People who use the service experience good quality outcomes in this area. Staff are aware of how to protect people from harm, and people know how to complain in a safe environment. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: People are aware of how complain or raise issues with staff. One person said ‘I know what to do, but I certainly don’t have any complaints to make’. Another person said ‘the home is wonderful, I have no complaints at all’. A complaints procedure is in place and both people using the service and staff are aware of the process. No formal complaints have been made to the CSCI, though one complaint was made regarding staff which has been investigated by the manager and found to be upheld. In the lounge a range of people were spoken with throughout the day. Whilst people were aware of how to complain some said they lacked confidence in the manager to effectively deal with their concerns. Though they felt either the deputy, other staff or the operations manager would deal with any issues. People in the home felt protected and safe, all staff spoken with including the manager had a good understanding of different types of abuse and the action to take if an incident occurred. It was evident that any situation where a person is at risk of harm or has been harmed would not be tolerated and clear action would be taken to protect the individual concerned. A whistle blowing DS0000007805.V333676.R01.S.doc Version 5.2 Page 15 procedure is in place and Four Seasons Healthcare have an adult protection policy in place. Staff receive training in this area as part of their NVQ training. DS0000007805.V333676.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 & 26 People who use the service experience good quality outcomes in this area. People enjoy living in this beautiful and clean environment, although the high air temperature may affect the wellbeing of some people. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: The environment people live in is decorated to a high standard, the entrance area and lounges are decorated beautifully with chandeliers, armchairs, sofas and a bar area to enjoy. All areas were clean and maintained to a high standard. A senior housekeeper oversees the domestic duties and all people spoken with regarding the cleanliness of individual rooms were extremely complimentary about all aspects of their rooms and the communal areas. Many people had large rooms with wonderful views over the Stray. One person who spends time in her room said ‘the views are stunning, I love spending time in my room’. DS0000007805.V333676.R01.S.doc Version 5.2 Page 17 During the day comments were made regarding the heat in the communal areas, and the stairs, landing and bathroom areas. Three people in the lounge said ‘it is really warm’, another said ‘its so hot, especially for the staff’, a further person said ‘I feel tired, I think it’s the heat’. Staff spoken with all commented on the heat of the building. Temperatures were taken in the communal area (where the fish are located), and on each of the three floors. The expected temperature is 21-23 degrees, and these temperatures varied from 30 degrees centigrade up to 31.5 degrees centigrade. This is too hot, staff need to feel well enough to care for people and whilst it is understood that the temperature needs to be quite high for this client group, this level is unacceptable. This situation was also made worse because staff wear quite thick uniforms which get very hot. The laundry area was inspected and found to contain sufficient washing machines and tumble driers for the amount of laundry to be washed and dried. Two staff in this area confirmed they have undertaken infection control training and are aware of wearing protective clothing to prevent cross-contamination. People using the service all looked extremely clean and well cared for, confirmation was given that the home carry out laundry duties to a high standard. It was evident that the machine used for ironing sheets was broken, and therefore a hand iron was used (one was domestic and the other heavy duty). Staff were concerned that a repetitive strain injury could occur as a result of using these irons. Ideally the roller machine needs replacing and two heavy duty irons need to be made available. Currently the laundry covers eighty people in two units and the flats next to the home. DS0000007805.V333676.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 & 30 People who use the service experience excellent quality outcomes in this area. People enjoy being cared for by staff who are competent, well trained and able to meet individual needs. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: People are cared for by staff who are competent, skilled and well trained. There are sufficient staff to meet individual needs during the day and overnight. One person said ‘I can ring my bell and the staff come to see me straightaway’. During the day buzzers were answered promptly and no-one was kept waiting. Staff receive NVQ training and people spoken to had undertaken NVQ level 2 or 3 since they had been employed at the home. The home have exceeded the expectations for the percentage of staff who have completed NVQ Level 2 training. This shows a strong commitment to training and development. All staff undergo a robust induction programme when they commence employment, this ensures people are cared for by staff who understand this client group. Staff confirmed the range of training which takes place during the first few weeks of employment. This is equivalent to Skills for Care (covers standards of care practices and health and safety). The home recruits people who have undertaken a criminal records bureau check and a protection of vulnerable adults check. Two written references are obtained, and three examples of this were inspected and confirmed. The manager is keen to ensure people using the service are protected from harm DS0000007805.V333676.R01.S.doc Version 5.2 Page 19 by staff been appropriately recruited. Comments from surveys confirmed that relatives feel staff are suitably trained and competent in their work. People discussed the staff and they clearly had faith in their abilities, and felt staff were an asset to the home. DS0000007805.V333676.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 & 38 People who use the service experience good quality outcomes in this area. The home is run in the best interests of people living there, with health and safety needs been generally met. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: People have their best interests understood and met by staff in the home. The manager is an experienced senior carer, who became the deputy and has now been the manager for about two years. She has completed a range of training including the registered managers award, adult protection, caring for this client group and mandatory training as part of Four Seasons Healthcare policies. Some people using the service and some of the staff did not feel they had confidence in the manager to effectively deal with certain issues. Three negative comments were received, however one comment was ‘I would always go to the operations manager if I had any problems’. This is partly due to the DS0000007805.V333676.R01.S.doc Version 5.2 Page 21 role the operations manager has within the organisation, and the expectations of this client group. Whilst these concerns need to be addressed, it was evident that the manager has worked extremely hard to ensure the transition to Four Seasons Healthcare was as smooth as possible, and many areas of paperwork have changed which staff need to work with. The issue with the air temperature was discussed with the manager who stated ‘this has been the same for twelve years’. The registered manager should have been monitoring the temperature and taken action accordingly. A discussion took place with the operations manager who immediately took action and obtained some air conditioning units as a short term measure. People are able to express their views and opinions either verbally or in writing through surveys and questionnaires. Resident and staff meetings take place, and action is taken when issues arise. The home have a quality assurance system in place which the manager is working through. Care plan audits were evident along with medication audits, a detailed system is in place to gather all this information. Staff speak verbally to people and the manager has discussions on a daily basis with people using the service to identify if they have any concerns. The home does not manager anyone’s finances. Items are invoiced to individuals which was confirmed by the manager and three people spoken with. Health and safety in the home was observed and discussed with the manager and maintenance person. People spoken with all said they felt safe in their environment. Fire safety checks are undertaken and a risk assessment has been completed. Emergency lighting was in place and door guards were evident on room doors. Staff have training in first aid, moving and handling, fire safety, infection control and food hygiene. Four Seasons Healthcare have a different system which staff are implementing regarding training. Water temperatures are within the normal range, five of these were tested. Certificates were available for electrical wiring, legionella and testing of equipment. Evidence of this was also available in the pre-inspection questionnaire. Staff confirmed which training they have attended and this means people are cared for in a safe manner. DS0000007805.V333676.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 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 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 4 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x x 3 DS0000007805.V333676.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 OP19 OP38 Regulation 23 (2) (p) Requirement People must not be exposed to high air temperatures which could effect their well-being. (highest temperature 31.5 degrees centigrade) Timescale for action 14/06/07 2. OP7 15 People must have their needs 12/07/07 documented on an individual basis, and general statements must not be made. This will ensure staff are aware of specific needs and appropriate action can then be taken. People must have their medication dealt with robustly to prevent errors occurring. -Stock balances of medication must be correct -Olive oil must be in date when used. This can be part of the homely remedy medication. -All handwritten entries relating to the type and dosage of medication must be signed for on the medication chart. 19/06/07 3. OP9 17 DS0000007805.V333676.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP26 Good Practice Recommendations Consideration should be given to replacing the roller iron in the laundry room, staff need suitable equipment to ensure peoples laundry is ironed effectively. DS0000007805.V333676.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 DS0000007805.V333676.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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