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Inspection on 25/06/07 for Lime Tree Manor

Also see our care home review for Lime Tree Manor for more information

This inspection was carried out on 25th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The care provided is of a good standard and staff are well supported by the training available to them, this is reflected in the generally very positive feedback received from people living in the home. "The carers are all lovely and look after us very well" was a typical comment. Procedures and practices for the safe use of medicines are of a high standard. Records of the receipt, administration and disposal of medicines provide a clear audit trail of medicines in use. This contributes positively to the safety and wellbeing of people living in the home. The home is clean and well maintained and provides a pleasant environment for those who live and work there.

What has improved since the last inspection?

As noted above, the medication practice of the home has improved. Steps have been taken to identify and address problems previously expressed by some people living in the home about staff for who English is not their first language, although this remains a problem for some people living in the home. No adverse comparison was made by people living in the home between day and night time staffing and care and this previous issue seems to have been satisfactorily addressed by the manager.

What the care home could do better:

The standard of dementia care, whilst adequate, could be further improved, for example by more positive interaction by staff. This is recognised by the staff and management team, and the training provided and commitment expressed provides for confidence that this will done. Some minor changes to the medication records and storage are necessary, although as noted above the overall standard found was good. Some minor adjustment to practice have been discussed with the manager, for example relating to information contained in menus and the display of menus to provide clearer and fuller information for people living in the home.

CARE HOMES FOR OLDER PEOPLE Lime Tree Manor 171 Adeyfield Road Adeyfield Hemel Hempstead Hertfordshire HP2 5JU Lead Inspector Jeffrey Orange Key Unannounced Inspection 25th June 2007 08:10 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 Lime Tree Manor DS0000019450.V343427.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. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lime Tree Manor Address 171 Adeyfield Road Adeyfield Hemel Hempstead Hertfordshire HP2 5JU 01442 217 755 01442 263 040 wilton.house@btconnect.com 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) Wilton House Limited Siji Sebastian Care Home 110 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (110), of places Physical disability over 65 years of age (110) Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 10th April 2006 Brief Description of the Service: Lime Tree Manor is a care home providing personal care and accommodation for 110 older people some of whom may have physical disabilities and up to 26 of who may also suffer from dementia. Detailed information about the services offered, including the latest report by the Commission for Social Care Inspection (CSCI) is displayed prominently in the reception area of the home. Fees for services range from £407 to £596 per week. Additional charges are made for newspapers, toiletries, chiropody and hairdressing services. This information was correct at 25.06.07 The home is owned by Wilton House Limited and is situated on the Adeyfield Road, a residential area of Hemel Hempstead, within easy reach of shops and facilities with good public transport links. The home is arranged over three floors in five units. Each unit has dining and lounge facilities, kitchenettes and assisted bathrooms and toilets. All the home’s bedrooms are single accommodation with en-suite facilities. There is a passenger lift and the home has a reception area, benches to sit on at the front of the home and two enclosed garden areas to the rear accessible to residents. Parking is available to the front of the building. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection site visit was undertaken by four inspectors one of who is a specialist pharmacy inspector and another who is a dementia care observation specialist. The inspection site visit provided an opportunity to speak to people living and working in the home, relatives and other visitors. Very positive discussions were held with the manager, deputy manager, senior staff and also the chief executive of Wilton House Limited. Care was case tracked by looking at key records and the records for recruitment and care planning were looked at in respect of recently admitted residents and recently recruited staff. The pharmacy inspector looked at the medication records of the home, with particular emphasis on those medicines prescribed for night sedation or those that may under certain circumstances have implications for the risk of falling. The dementia observation was carried out over two hours in the dementia unit, observing the experience of care for people with dementia in the lounge area of that unit. During this time three people were observed in depth, information was also obtained from care plans and by talking with the staff responsible for care in that unit including the senior staff and management team. This report also makes use of information contained in service user surveys received since the last key inspection in April 2006 and also information provided by the home in their annual quality assurance self-assessment submitted to the CSCI. The site visit was used to follow up and address any outstanding concerns from a serious concerns meeting process involving the home, which was recently concluded. The management of the home and Wilton House Limited cooperated fully in that process. The visit also provided an opportunity to monitor the progress made in meeting other specific concerns about the home raised with the CSCI, which had been the subject of two additional visits to the home in November 2006 and March 2007. This was a very positive inspection site visit and this is reflected in the good outcomes recorded. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The standard of dementia care, whilst adequate, could be further improved, for example by more positive interaction by staff. This is recognised by the staff and management team, and the training provided and commitment expressed provides for confidence that this will done. Some minor changes to the medication records and storage are necessary, although as noted above the overall standard found was good. Some minor adjustment to practice have been discussed with the manager, for example relating to information contained in menus and the display of menus to provide clearer and fuller information for people living in the home. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 7 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. Lime Tree Manor DS0000019450.V343427.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 Lime Tree Manor DS0000019450.V343427.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 3 4 (Standard 6 does not apply to Lime Tree Manor) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective and comprehensive system of pre-admission assessment in place to ensure that the care needs of people considering moving into Lime Tree Manor are fully identified and can be fully met. Staff are provided with the training and support that they need to obtain the necessary knowledge and skills to meet the varied care needs of people living in the home. There is clear and well presented information available to people considering moving into Lime Tree Manor. This should enable them to make a wellinformed decision about the home, its cost and whether they will feel comfortable and safe in it. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 10 EVIDENCE: Inspectors had the opportunity to speak to several relatives about the home and how they had chosen it, there was a consensus that the information provided was good and that the reality had in general met their expectations. The Service User’s Guide and Statement of Purpose are comprehensive and clearly written and include very full information about fees, what is included and what is not and this should mean that people considering moving into the home have an accurate idea about the cost involved. Care plans were seen to include a robust and thorough process of assessment. This should mean that only those people whose care needs can be appropriately met are admitted into the home. Those members of the staff team spoken to were very positive about the training they receive and training records provided details of a range of relevant training both completed and planned for the future. Lime Tree Manor DS0000019450.V343427.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Practices and procedures for the safe handling of medicines are of a high standard. The records of the receipt, administration and disposal of medicines are well maintained, provide a clear audit trail of medicines in use and show when people who use the service are given their medicines. The standard of care planning is good, personal healthcare needs are clearly recorded in each residents’ care plan, they provide a good overview of the needs of the individual and how they are to be met, taking into account the personal preferences of the person receiving care. Staff respect the dignity of people living in the home and are sensitive to their right to determine how their care is delivered. Daily notes would be improved if there were additional information about social interaction and activity as well as that dealing with personal care, diet and sleeping patterns (for example). EVIDENCE: Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 12 “The carers are superb” was the comment of one person living in the home and this view was supported in conversations with many other people living in the home and with relatives and visitors. Care plans were well completed and included evidence of review to identify changes in care needs. Although the overall standard of medication records was good, a few of the records didn’t clearly indicate the date that medicines were given and staff must remain vigilant that these records are completed properly so that residents are not given medicines inappropriately, assurances that this will be done were given at the inspection. Clear and detailed medicine handling procedures are available to the care staff. Those aspects of the policy that were found not to have always been followed in full, for example, the monitoring and recording of the medication storage rooms temperature on a daily basis were discussed with the management team and action was taken during the inspection visit to fully address any concerns. Throughout the observation carried out in the dementia unit, good moving and handling techniques were observed with the staff explaining to people they were helping what was happening and why and making sure that they were comfortable during the manoeuvre. Daily notes were found to be well completed in terms of personal care but less comprehensive in terms of social interaction and activities. This makes it harder to obtain an accurate understanding of the way that the holistic care needs of people living in the home are being met. Lime Tree Manor DS0000019450.V343427.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are given the opportunity to take part in a variety of activities, most of which take place in the home, it would broaden the appeal of activities overall if greater use could be made of facilities and services outside of the home. The food in the home is of a satisfactory quality, is well presented and meets the dietary needs of people living in the home. People living in the home are consulted regularly about the home and its operation in order for them to have an opportunity to influence decisions made about the routines of daily living. Those people living in the home who have dementia would benefit from increased opportunities for staff to interact with them on a one to one basis, as positive reaction was noted where this was being achieved. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 14 EVIDENCE: People living in the home confirmed that activities staff consulted them and that they were encouraged to attend some activity sessions. Positive discussions were held with the activities staff about the provision of activities, possible improvements and access to some organisations and publications, which may offer guidance and examples of good practice. “I would like to get out more” was one comment made, which suggests that increased access to the community might be welcomed, if it can be arranged on a regular basis. The observation carried out in the dementia unit noted some good practice and some which could be refocused and improved in order to provide more stimulation and involvement by those people living in the home who have some degree of dementia. Very positive discussions were held between the inspector who carried out the observation on the dementia wing and the relevant staff team. A high level of commitment for the improvement and development of dementia care in the home was evident. The home has recently had its accreditation with Hertfordshire County Council as a provider of dementia care services confirmed for a further period. Menus on display were for a four- week period, with no indication which week was applicable. People living in the home confirmed that alternative choices, such as salads and vegetarian options were available, they were not however set out on the menu on a daily basis. Lime Tree Manor DS0000019450.V343427.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints policy and procedure, together with appropriate and relevant staff training in the recognition of issues around the safeguarding of vulnerable adults and the correct response if it is suspected should provide confidence in this service for residents, their relatives and those who care for them. EVIDENCE: The home has a comprehensive complaints procedure, which is well publicised in documentation provided to people who live in the home, and information about it is displayed in the home. People in the home have indicated either in conversation or through surveys that they are aware of the complaints policy and that they would feel able to raise any concerns with staff. In the period since the previous inspection a number of complaints or issues have been notified to or raised with the CSCI and there has been a serious concerns procedure under Hertfordshire County Councils’ safeguarding process. Lime Tree Manor and Wilton House Limited have co-operated fully with this process, which has, at the time of this report, been concluded in respect of Lime Tree Manor. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 16 Whilst some specific issues are still in the process of being actively discussed with those who raised them, this visit provided an opportunity to deal satisfactorily with other issues raised. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 17 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): Standards 19 20 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and comfortable, well furnished and maintained and this provides a pleasant environment for people who live or work in it. The number and location of communal areas and toilet facilities meet the needs of people living in the home, there are a variety of lounges of differing sizes, where people living in the home can choose to be quiet, watch television or take part in activities. The courtyard gardens are accessible to people living in the home and provide an opportunity for those who enjoy gardening or watching birds. Further development of, for example a sensory area would further enhance this provision for people living in the home. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 18 EVIDENCE: During this site visit, people living in the home were seen to be making use to the various communal areas available to them. In conversation with people living in the home, several confirmed that they enjoyed using the garden areas when the weather permitted. The possibility of making a sensory garden, which would benefit all people living in the home, including those with dementia, was discussed with the management and activities staff. One person living in the home has provided themselves with their own hanging basket outside their room to enhance their enjoyment of the garden; another person does some gardening as part of his activity programme. There were no problems with unpleasant odour identified during this visit and people living in the home and those visiting them praised the standard of cleanliness they experienced. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 19 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): Standards 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient care staff, administrative support staff and management, with the necessary skills, training and supervision support to provide adequately for the well being of people living in the home. Recruitment practices are robust and should offer protection to people living in the home from the employment of unsuitable care staff. EVIDENCE: People living in the home were very positive about the staff team, with only some reservations about the language skills expressed previously and with no repeat of the concerns about evening staff mentioned in the previous report. Language training for those identified as requiring it has been put in place, this needs to be constantly monitored to ensure people living in the home can continue to have confidence in their ability to communicate appropriately with all staff providing them with care. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 20 The home has an impressive number of staff with at least NVQ 2 in care and have recently put in place an in-house NVQ assessment team. Dementia care training is in place at various levels and is being given an increased priority. Recruitment files for recently recruited staff were examined and found to include the required checks to provide confidence and reassurance to people living in the home that unsuitable people will not be employed to care for them. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 21 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): Standards 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team at Lime Tree Manor work together to provide for the effective and efficient management and administration of the home which benefits all those who live and work there or who are associated with those who do. EVIDENCE: The manager and her management team are well qualified and experienced in the management of care services for older people. There is a range of quality assurance measures and procedures in place, including some innovative use of “narrow focus” surveys of people living in the home, covering subjects such as activities and evening care provision. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 22 Residents and relatives spoken to were supportive of the home. It is acknowledged that some relatives have contacted the CSCI with concerns about the home since the previous inspection and the outcome of the discussions between them and the management of Wilton House Limited are being monitored. Overall the feedback received has, however, been positive. The system in place for the safeguarding of monies, held by the home on behalf of people living there, was found to be adequate and assurances were given on behalf of Wilton House Limited that this would continue to be closely monitored. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 23 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Daily notes for people living in the home should wherever possible include details of social interaction and activities undertaken. The activities staff should be supported to investigate the possibility of improving the use of and access to community facilities and services by people living in the home. Activities staff should be encouraged to obtain details of research and resources available in respect of activities, including for people with dementia, this might include membership of appropriate specialist bodies and obtaining subscriptions to appropriate publications. The manager should review the activities budget in the light of the above to ensure that it is adequate. Menus should be revised to ensure that vegetarian and salad options are clearly indicated each day. It would also help clarity if menus were only displayed for the current DS0000019450.V343427.R01.S.doc Version 5.2 Page 25 OP12 3. OP12 4. 5. OP12 OP14 Lime Tree Manor 6. OP30 week, rather than the full four- week cycle. The manager should continue to monitor the language skills of all staff to ensure that they are able to communicate orally and in writing sufficiently well to meet the needs of people living in the home and to maintain records appropriately. Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Lime Tree Manor DS0000019450.V343427.R01.S.doc Version 5.2 Page 27 - 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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