Inspection on 03/02/06 for Linden Lodge Nursing Home

This inspection was carried out on 3rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Linden Lodge Nursing Home 24/01/08

Linden Lodge Nursing Home 16/01/07

Linden Lodge Nursing Home 25/08/05

Linden Lodge Nursing Home 01/03/05

Linden Lodge Nursing Home 27/09/04

Linden Lodge Nursing Home 07/11/02

Linden Lodge Nursing Home 07/11/02

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Linden Lodge Nursing Home Church Road Warton Tamworth Staffordshire B79 0JR Lead Inspector Jackie Howe Unannounced Inspection 3rd February 2006 09:15 X10029.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 Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 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 and Care Homes for Adults 18 – 65*. 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. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Linden Lodge Nursing Home Address Church Road Warton Tamworth Staffordshire B79 0JR 01827 894082 01827 896420 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) Linden Lodge Care Homes Limited Mrs Linda Lowrie Care Home 65 Category(ies) of Dementia - over 65 years of age (65), Old age, registration, with number not falling within any other category (65), of places Physical disability (0) Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th August 2005 Brief Description of the Service: Linden Lodge is situated in the countryside, close to the village of Warton. Originally it was a country house. It was converted into a care home and then extended to provide accommodation for up to sixty-five service users. One bed is reserved for nurse-led admissions on a rolling respite basis. The care home provides nursing and personal care for both elderly people and younger disabled people. The focus of care delivery being on general nursing and personal care. No specialist rehabilitative services are provided. A planned programme of social activities and entertainment is provided in the home. Service user accommodation is mostly provided on the ground and first floor, although there are three bedrooms and some communal space for more able people on the top floor. There are forty-eight bedrooms, all with en-suite facilities, of which fifteen are doubles. There are four lounges and a library as well as the usual domestic and office accommodation. The grounds are pleasant and wheelchair accessible. There is ample parking and the home is on the main public transport route to Atherstone and Tamworth. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours and was unannounced. This was the second inspection of the current inspection year 2005/06. The manager was not present on the day, but a tour of the home was conducted with the owner Mrs D Leyland, and during the inspection five staff, and five residents were spoken with. On the day of the inspection residents and staff in the home were affected by a sickness bug, so that strict infection control measures were in place which prevented the inspector from access to many residents’ personal rooms and from speaking to residents individually. The inspection included speaking with staff and residents, accessing records, reading care plans and observing care practices. What the service does well: What has improved since the last inspection? A new care planning system has been introduced over the past few weeks in response to requirements at the last inspections. Some of the care plans were informative and included examples of detailed pre-admission assessments. As this is a newly introduced system, some care plans were more complete than others. One care plan had only the daily diary sheets completed. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 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. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) 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, 6 There is a newly introduced needs assessment in place that adequately provides staff with the information they need to satisfactorily meet service user needs. Residents using the intermediate care beds, are supported by relevant professionals, to return home as soon as possible. EVIDENCE: Care plans for two new residents and two residents receiving intermediate care were read. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 9 Needs assessments were completed to a high standard and gave clear indication and direction to staff in completing a care plan. Residents admitted to the home through Care Management arrangements, had a health and social services assessments in place. Care plans showed evidence of recordings and visits to the home by the local GP and visits from other health care professionals, and that discussions had taken place with the intermediate care team to ensure a safe return home. A complaint regarding the care received by a resident receiving intermediate care at the home is currently being investigated. Staff are trained and supervised within the home’s ongoing training plan to provide care to the residents receiving this service. Staff spoken with said that they benefited from the variety in their workload, and that student nurses on placement to the home were given a good insight into the rehabilitation needs of people leaving hospital. The provision for residents receiving intermediate care is not within a dedicated area in the home, nor are staff specifically employed to provide intermediate care. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 Care plans are slowly improving, some elements are full and informative, however further development is needed to provide the staff with the necessary information to meet individual residents’ needs. Medication administration records are not accurate and the management of stock is not efficient. This places residents in a position of risk of harm. Risk management must be more robust to ensure that strategies to minimise risk are understood by staff and recorded on the care plan. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 11 EVIDENCE: A new care planning system has been introduced to the home over the past few weeks. Staff have been allocated additional hours to complete the care plans and the risk assessments. As in the introduction of any new systems, staff are adjusting to the new paperwork, and some care plans have been completed better than others. One care plan had very little content apart from the daily diary sheets where staff had recorded daily events. Risk assessments had not been completed, nor had directions to staff in regard to her high care needs. Risk assessments have been completed in great detail in some areas particularly in regard to falls, nutrition and tissue viability, however this is not consistent and staff spoken with, were not sure about the new paperwork and if risk assessments were kept within the care plan, or in an alternative care file. The manager has introduced a system to alert staff to the fact that risk assessments are in place. Risk assessments for the provision of bed rails were not seen in one care plan. Health care needs are addressed by the home with staff that are trained to do so. Hearing, dental and optician services are available. Systems in place for the administration, storage and stock control of medication are not sufficiently robust to keep residents safe. Gaps were seen in administration records, and the manager confirmed that there was sometimes a problem with the receipt of correct stock, but said that this was being addressed. A complaint about errors in medication administration had been received by the commission and has been upheld. Staff said that they were aware of these shortfalls and felt confident that they would be addressed. The medication policy is held with access for all staff, but a member of staff questioned was unclear about the storage of medication for deceased residents. Systems and procedures for the administration, receipt and storage of controlled drugs were seen to be satisfactory. Two medications were checked and found to be correct. Residents who wish to self medicate are assessed and their ability to continue to do so is reviewed. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not assessed, residents spoken with confirmed that they had choice over how they spent their day and spoke well of the meals they received. Lunchtime was observed and those residents needing assistance were seen to be treated with dignity and receive their meal at a pace appropriate to them. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not fully assessed, a tour of the home confirmed that the home is well maintained and in a good state of decoration. Lounge areas and dining rooms are well furnished, with a choice of communal areas available to spend the day, plus a quiet lounge to entertain visitors or hold meetings. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 15 The inspector, due to the infection control measures in place, did not enter personal bedrooms. The garden courtyard is particularly attractive. The lack of a dedicated space so that younger residents share dining and communal areas with older and frailer people was not seen as a problem by the staff, but one younger resident said that he found the lounge area to be a little ‘depressing’ as there was a lack of same age people to talk to, but did not choose to move too far from his bedroom. Another younger resident said that she found it difficult sharing her bedroom with an older person particularly at night time. She was aware of the reasons she needed to share, but said she found the lack of privacy difficult. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 The home provides sufficient numbers of staff with the skills mix necessary to meet the needs of service users. An ongoing programme of training is provided to all staff to ensure residents’ needs are met and sufficient staff are provided to meet residents’ needs. EVIDENCE: The home currently enjoys good staffing levels with additional staff employed to undertake laundry, kitchen and domestic duties, along with someone employed to maintain the home and the garden. An overlap of staff in the mornings allows for a higher number of staff available at peak times. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 17 On the day of the inspection, the home had two student nurses on placement from Coventry and Warwick Hospital, who are supervised by the nursing staff. The students are supplementary to the staffing rota. The home does not currently employ agency staff. The registered provider confirmed that all staff receive a minimum of three paid training days per year. New staff follow an induction programme and are given sufficient supernumerary time and then supported by a mentor to complete the induction and attend mandatory training. Two of the nursing staff have completed a 4-day dementia care course, and additional training support is available from the sister residential home. Eight of the care staff are currently undertaking their NVQ level 2 in care, which will bring the home nearer to its 50 target. The home attained the Investors in People (IIP) award in December 2005. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Systems within the home are aimed at ensuring that the health and safety of residents and staff are protected, but although the home promotes a range of health and safety policies and procedures, there are a number of shortfalls in respect to individual risk assessment that place residents at risk. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 19 EVIDENCE: The home is well maintained and appears to offer a safe environment to its residents. Staff receive training in all aspects of health and safety, and the home undertakes an annual audit programme. A health and safety policy is in place, and reviewed. Evidence was seen of staff having participated in regular fire drills, and an annual fire lecture. A current ‘sickness bug’ in the home was affecting both staff and residents. The home was seen to be handling this effectively and good infection control procedures were being used. During a tour of the home, a cleaning trolley containing chemicals was noted to be unattended for a period of time. This could place residents at risk. Individual risk assessments for some residents are not present in all care plans either to identify risk, or give clear instructions to staff on how to minimise risk for individuals. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 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 x 2 x 3 3 4 x 5 x 6 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x ENVIRONMENT Standard No Score 19 x 20 x 21 x 22 x 23 x 24 x 25 x 26 x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 x 36 x 37 x 38 2 Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 21 yes 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 OP7 Regulation 12 Requirement The registered manager must ensure that all residents have a completed care plan which sets out in detail the action to be taken by staff to meet all the needs of the residents in their care. (Previous timescale of 30/11/05 not fully met.) The registered manager must ensure that accurate records of the administration of medication are kept. Records must show whether medication has been administered/ not administered, refused or the resident was absent. The registered manager must ensure that risk assessments for all residents are completed and regularly reviewed and updated, and that all staff are aware. All residents who are using bed rails must have a risk assessment completed. Timescale for action 01/04/06 2 OP9 13 03/02/06 3. OP38OP7 13 01/04/06 Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 22 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 YA21 YA25 Good Practice Recommendations To increase choice to residents and reduce the risk of cross infection, the registered manager should identify ways of installing more separate showering facilities in the home. The registered manager wherever possible, should offer alternative accommodation according to the wishes of the residents. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. Linden Lodge Nursing Home DS0000004400.V281401.R01.S.doc Version 5.1 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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