Inspection on 30/05/06 for Huntercombe Hall Care Home

This inspection was carried out on 30th May 2006.

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

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

Other inspections for this house

Huntercombe Hall Care Home 23/07/07

Huntercombe Hall Care Home 07/02/06

Huntercombe Hall Care Home 04/08/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Huntercombe Hall Care Home Huntercombe Hall Huntercombe Place Nuffield Henley on Thames Oxfordshire RG9 5SE Lead Inspector Philippa MacMahon Unannounced Inspection 30th May 2006 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 Huntercombe Hall Care Home DS0000063474.V295638.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. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Huntercombe Hall Care Home Address Huntercombe Hall Huntercombe Place Nuffield Henley on Thames Oxfordshire RG9 5SE 01491 641792 01491 641761 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) Huntercombe Hall Limited Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one named under age resident Date of last inspection 7th February 2006 Brief Description of the Service: Huntercombe Hall is registered to provide nursing care for up to 48 male and female service users aged 60 years and over. Registered nurses are on duty 24 hours a day. The home is in a rural part of Oxfordshire and public transport is limited. There is a country bus service, but the bus stop is some distance from the home. The public rooms are spacious and are on the ground floor. There are 40 single and 4 double rooms situated on the ground and first floors with each room having its own en-suite facilities of toilet and washbasin. Two single rooms have an en-suite shower suitable for infirm residents. There is a pleasant patio with garden tables and chairs accessible from the conservatory that overlooks the home’s extensive grounds. The fees for this service range from £350 to £650 per week. Huntercombe Hall Care Home DS0000063474.V295638.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 service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09.30hours and was in the service for 7½.hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. 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. The home does not at present have a registered manager in post and the company has provided an experienced peripatetic manager (Mr Donald MacLeod) to manage the home until the vacancy is filled. Mr MacLeod was on duty and present throughout the inspection. A regional manager from the company was present for part of the day and stayed for the feedback at the close of this inspection. The inspector was made to feel very welcome by all the staff and really appreciated their cooperation. Care plans were examined and this was followed by meeting with the residents to see if the care needs were being met. The medication system was examined, and discussed with the senior nurses on duty. The activities coordinator met with the inspector and discussed the plans to develop social and recreational activities for the residents. The inspector joined the residents for lunch in the dining room, observed staff assisting the residents, and met with the Chef to discuss the menus following this. A tour of the premises was made including the grounds. The administrator met with the inspector and facilitated the examination of records including staff records, residents’ contracts and the management of their cash for sundry expenditure. The fire log, and the service documentation for the boilers, hoists, gas, and electrical equipment were also examined. The inspector met with residents, relatives, and visitors to the home. The Manager had completed a pre-inspection questionnaire provided by the Commission and the information from this was used to help to plan the inspection. The Commission also provided questionnaires for the residents to complete to help inform us of the care provision. Only two of these were Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 6 completed and returned to the Commission. One relative had completed the relatives/visitors comment card. The fees for this service range from £350 to £650. What the service does well: What has improved since the last inspection? What they could do better: The system of monitoring the progress of wound healing needs to be improved. The registered nurses need to review the Nursing and Midwifery Council’s guidelines for the administration of medicines to ensure that correct procedures are in place. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 7 The procedure for the repair or replacement of necessary equipment and maintenance faults needs to be improved to ensure the health, safety, and welfare of residents, staff, and visitors. The maintenance of the garden and grounds needs to be carried out. 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. Huntercombe Hall Care Home DS0000063474.V295638.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 Huntercombe Hall Care Home DS0000063474.V295638.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. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has a full assessment of his or her care needs prior to being admitted to the home. Intermediate care is not provided at this service. EVIDENCE: Four care plans were examined and each had a pre-admission assessment that reflected the care needs of the residents. These assessments are carried out by the manager and other supporting information from other health care professessionals is included. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has a care plan that is regularly reviewed. The health care needs of the residents are met. EVIDENCE: A sample of six care plans was examined and four of these were case tracked. Overall the plans gave a good picture of the residents’ care needs and how these are met. The documenting of the progress of wound healing was unclear in that no measurements had been made, and the photographs taken were very poor. It is recommended that the registered nurses should look into effective ways of monitoring and recording the progress of wound healing. It was also noted that a number of residents had a history of falling and the inspector recommended that the manager should contact the Oxfordshire Falls Unit for advice on how best to manage this problem. The nurses are able to access specialist nurses, and the tissue viability nurse has recently visited the home to discuss wound care. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 11 Overall the system of managing medication is good and appropriate ordering, storing, and administration of medicines are in place. The home has recently changed provider and there have been a few minor difficulties that have been sorted. Examination of the controlled drugs held showed that the dose of Morphine Sulphate tablets had been changed on the label of the box, and the Medicines Administration Record, which had been written long hand by one of the nurses and not countersigned by the GP. This is poor practice and the registered nurse took immediate steps to get this corrected. It is recommended that all the nurses involved with medication should be made aware of the Nursing and Midwifery Council Code of Practice in the administration of medicine, to ensure that safe practices are implemented at all times. It was noted that the morning drug round went on for a long time, and there was little space between this and the midday round. The manager told the inspector that this had been raised recently and that they were looking at various options that included possibly changing the times that meals are served. The staff were observed to treat the residents with dignity and respect, by always knocking on doors before entering a resident’s room, and addressing them by their preferred term of address. Huntercombe Hall Care Home DS0000063474.V295638.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good progress is being made into improving the social/recreational opportunities for the residents, and in improving the quality of the meals and mealtimes. From the evidence seen and comments received the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religions, race, or culture. EVIDENCE: The inspector met with the activities co-ordinator who is relatively new in post, and she has already made a significant contribution to the social/recreational activities in the home. She has met with every resident on a 1-1 basis to find out what their interest and needs are and is developing an interesting plan of activities. One recent outing was to a local zoo and was much enjoyed by all. There is an attractive collage of photographs recording this event displayed in the entrance hall. The local churches do support the residents but at the moment there is no regular communion service as there has been a change in the Vicar. However a group of ladies called the Singing Angels visit the home regularly to sing well known hymns, and secular songs. There is good Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 13 evidence that residents are able to make choices in their every day lives. One resident has tea making facillies, and a fridge in her room so that she can make snacks for herself. A number of residents choose not to socialise and remain in their own rooms. One resident spoken to is rather hard of hearing and finds it difficult to be with other people who do not understand her difficulty. It is recommended that staff should undergo some form of training on how to assist people who have a hearing deficit. The inspector joined the residents in the dining room for lunch and enjoyed a tasty meal that was well presented. The residents at the same table said the food here is good, and we are always given a choice of meal and if we do not like what is offered on the menu, we can choose something else”. The dining room was very crowded and this was made more difficult as a number of people were in wheelchairs. There was also a lot of coming and going of people in wheelchairs that required others to be moved during the course of the meal. The manager informed me that this was being addressed and at a meeting on the day of the inspection they had agreed to trial having two sittings. A menu survey had just been completed by the activities coordinator and the findings were discussed at this same meeting, which was attended by the company’s Regional Manager, Chef, the activities co-ordinator, the manager and one of the unit managers. A new seasonal menu had been agreed, and various other changes to improve meals and mealtimes. Huntercombe Hall Care Home DS0000063474.V295638.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints system in place that is accessible to residents, relatives, and visitors to the home. There are systems in place to protect residents from abuse. EVIDENCE: A copy of the complaints process is posted in the entrance hall, and is included in the Service Users Guide. Complaints and concerns are filed in a folder and issues had been dealt with in accordance with the complaints procedure. The Commission has received an anonymous letter with a number of concerns that need addressing by the Manager. A copy of this document is being forwarded to the manager for action and response to the Commission. The training records seen showed that all the staff receive training in the protection of vulnerable adults as part of induction and ongoing. Huntercombe Hall Care Home DS0000063474.V295638.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the home provides a pleasant comfortable, and homely environment. There are issues about obtaining authority to progress work necessary for maintaining standards. EVIDENCE: The inspector toured the building and found all areas to be clean, orderly, and the decor and furnishings to be of a high standard. The stained carpet in the entrance hall and front communal sitting room is about to be replaced. One of the resident’s rooms is also about to have the floor covering changed. Random sampling of the hot water outlets was made by the inspector and the temperatures were found to be around 43ºC. The assisted shower room on the first floor has black plastic taped to the tiles in the shower area. The manager said that this was awaiting the facilities Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 16 team from head office to carry out the work, as the home’s maintenance person is on long term sick leave. This has been in this condition since February. This shower is used often by the residents. It is a requirement that the repair must be completed, as it is in the inspector’s view a risk to health and safety of residents as the area cannot be cleaned appropriately. The inspector observed 7 doors with acoustically sounded door closers propped open with various implements. Two of these malfunctioning closures were in the kitchen. The manager explained that these were all malfunctioning and again they were waiting for authority from head office to progress the necessary work. The local fire service had recently attended a faulty fire alarm system and had also commented on the doors being propped open. It is an immediate requirement that the broken door closures must be repaired and made good, and the manager must fax evidence to the inspector that the work has been actioned by 5th June, and a further notification on completion of the work. The assisted w.c. on the ground floor had two open bags of new incontinence pads on the floor. This is not good practice as they could pose a trip hazard as well as being unsightly. It is recommended that appropriate provision should be made to store incontinence pads other than on the floor in the toilets. The laundry was found to be in good order and the residents’ clothing well cared for. The home had recently had an incident when there was no water supply and they were unable to use the washing machines. This was well managed by the manager, laundry and other staff to cause minimum disruption to the residents. The kitchen was found to be clean and orderly. The chef told the inspector that the food store was very small for their requirements, and he is looking into ways of creating more space in this area, to allow ease of cleaning the area. The liquidiser machine is out of order and has been for some time, and the staff are making do with a small hand held blender. This is very time consuming as a number of meals need to be liquidised. The fault has been reported and is awaiting authority to be repaired. The regional manager told the inspector that this would be rectified immediately. The grounds were very overgrown, and one of the residents commented Lovely home, would like the garden to be made more attractive. Gives a poor appearance to the home. The regional manager informed the inspector that this work was being put out to contract that day. Huntercombe Hall Care Home DS0000063474.V295638.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are good and the required recruitment checks for new staff are obtained. The standard of 50 of all care workers having achieved National Vocational Qualification level 2 in care has not yet been achieved but progress is being made. The training and development plan for staff is in place with evidence of training having taken place. EVIDENCE: The rosters were examined and found to show that sufficient numbers and skill mix of staff were on duty at all times. A sample of staff files was examined and found to be complete and in accordance with the home’s recruitment procedure. The percentage of care staff with National Vocational Qualification level 2 and above is 33 percent at the present time. It is hoped to reach the standard of 50 in the near future as further staff are registered on the programme. The inspector examined a comprehensive training matrix, which showed that all staff are involved in training and development. The induction programme is based on the Skills for Care Council approved induction training programme, and all new members of staff are required to complete this. All staff are provided with the opportunity to further their individual learning and development. Staff spoken to felt that they had a good training and were competent to provide the best care for their residents. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed but there is uncertainty amongst the staff until a new manager is appointed. The administration is good, and there are adequate systems in place to protect the residents. EVIDENCE: The present manager is a peripatetic manager who is managing the home until such time as a new manager is appointed. The recruitment process is underway and the Regional manager said that it is hoped to appoint somebody very soon. The staff spoken to speak highly of the present manager and wish that he could stay. There was good evidence of team work amongst all the staff. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 19 The company have quality systems in place, and the menu audit that has just been completed is a good example of client focused quality improvement. The inspector met with the administrator and examined records required by regulation, records of the residents’ cash for sundry items and accompanying receipts of all transactions made. Staff do not enter into any individual resident’s financial matters, this is dealt with by relatives or representatives. The payment of fees and all other financial matters are dealt with by head office. The training record showed that staff have training in moving and handling, fire safety, and food hygiene. The inspector examined the service and maintenance documentation for hoist, gas, boilers, washing machines and dryers, the fire log, and found these to be up to date. However issues of the lack of maintenance to door closures, and the assisted shower as evidenced in the Environment section of this report are areas of concern. The maintenance person is unwell at the present time and additional help is being sourced at the present time. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 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 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 3 Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 23(2)(b) Requirement It is a requirement that the repair must be completed as it is in the inspector’s view a risk to health and safety of residents as the area cannot be cleaned appropriately. It is an immediate requirement that the broken door closures must be repaired and made good, and the manager must fax evidence to the inspector that the work has been actioned by 5th June, and a further notification on completion of the work. Timescale for action 04/07/06 2 OP19 23(4)(iv) 05/06/06 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. Refer to Standard OP8 Good Practice Recommendations It is recommended that the registered nurses should look into effective ways of monitoring and recording the progress of wound healing. DS0000063474.V295638.R01.S.doc Version 5.2 Page 22 Huntercombe Hall Care Home 2. 3. OP8 OP9 4 5 OP12 OP26 It is recommended that the manager should contact the Oxfordshire Falls Unit for advice on how best to manage this problem. It is recommended that all the nurses involved with medication should be made aware of the Nursing and Midwifery Council Code of Practice in the administration of medicine, to ensure that safe practices are implemented at all times. It is recommended that staff should undergo some form of training on how to assist people who have a hearing deficit. It is recommended that appropriate provision should be made to store incontinence pads other than on the floor in the toilets. Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU 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 Huntercombe Hall Care Home DS0000063474.V295638.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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