Inspection on 17/08/06 for Morton Grange

This inspection was carried out on 17th August 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

Morton Grange 08/02/06

Morton Grange 13/09/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Morton Grange Stretton Road Morton Alfreton Derbyshire DE55 6HD Lead Inspector Ivan Barker Unannounced Inspection 17th August 2006 09:00 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 Morton Grange DS0000002066.V308277.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. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morton Grange Address Stretton Road Morton Alfreton Derbyshire DE55 6HD 01246 866888 01246 861757 enquiries@mortongrange.co.uk www.mortongrange.co.uk Inverhome Limited 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) Mrs Doreen Teanby Care Home 66 Category(ies) of Dementia (66), Old age, not falling within any registration, with number other category (66), Physical disability (66), of places Terminally ill (66) Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Morton Grange care home is located in the village of Morton with shops, pubs and other amenities nearby. The care home consists of two buildings. The Beeches unit is a converted building and The Poplars and The Willows units are purpose built. There are nine day/quiet rooms included within the communal facilities. Fifty-four of the homes bedrooms comprise single accommodation, with twenty of these providing en-suite facilities. Six of the bedrooms offer shared accommodation, with two of these providing en-suite facilities. Passenger lifts are provided. There are extensive gardens that are well maintained and easily accessible. Car parking space is to the front of the building. At the time of the visit, the current fees range between £289.70 and £459.40. There were also various additional charges for hairdressing, chiropody, and ensuite bathing facilities. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Only a limited number of the National Minimum Standards were examined at this inspection (with emphasis on the ‘key standards’). The persons present at the inspection were: Mrs D Teanby, manager. Mr and Mrs Rye, owners / directors Pre inspection work was undertaken prior to the inspection. Then within this inspection, which occurred over a seven hour fifteen minute period, the inspector toured the two buildings, examined documentation and spoke with service users, relatives, staff, manager and owners / directors. A part of the inspection process, the method of case tracking was used. This means that specific service users were selected as part of the process and their care and service provision examined, and their views sorts, as well as those of other service users, relatives etc. Within ‘The Service Information’ section of this report it states that one of the registration categories, that the home is registered for, is Terminally Ill. This category is no longer part of the CSCI registration categories. Therefore the category will be removed from the registration of Morton Grange, and a new certificate provided. What the service does well: This service has been recognised as a home that was achieving most of the standards consistently over several years. It should be recognised that this inspection was unannounced. Throughout the inspection process, the inspector observed practices and overheard and received comments, which indicated that a positive ‘team ethos’ had been achieved, and that staff were working together for the benefit of the service users. The manager, owners and staff explored through the evaluation of the care and service new initiative to enhance the care and service provision, and take on board suggestions from staff, relatives etc. Positive comments from service users and relative were received by the inspector, and are stated in the body of this report. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Accurate assessments will ensure that the home has sufficient information to be aware of the service user’s needs prior to admission. EVIDENCE: The home received service user’s assessments from the Social Services Care managers or the Hospital staff, prior to admission. The manager prior to the admission to the home assessed the service users. The inspector was shown evidence of the assessments of the service users, who he case-tracked. The assessment documents were available within the care plans. Also care reviews were also included within the plans. Regarding Standard 6, the manager advised the inspector that the home did not provide intermediate care. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Accurate care plans and care reviews with service users and relatives enabling them to offer their input, will contribute to the delivery of care. Service users were satisfied with the care they received. The good practices within storage and administration of medications should provide protection for the service users. EVIDENCE: On examination of the care plans, from the service users who were being case tracked, the inspector established that all six plans were up to date, and had been evaluated on a monthly basis. The inspector selected service users from each of the three units within the home. Different daily entry records were being used within one of the units. The manager advised the inspector that one unit was using up the ‘old stock’ and the other units had moved onto the new documentation. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 10 The inspector discussed the service users’ care needs with care staff, who were knowledgeable about the service users’ needs. Risk assessment were included within the documentation and included moving and handling, pressure area, and nutritional, risk assessments. Turn charts and fluid charts were situated within the service user’s rooms. On examination of these documents the inspector found that the documents had been completed and were up to date. The manager discussed the benefits of the charts being readily available rather than in the files. She identified that although the provision of charts provided a more ‘clinical’ rather than ‘homely’ environment, this system was working well, and ensured that care was being delivered. The inspector accepted this point. The inspector observed that all the frail service users appeared very comfortable and well cared for. The inspector spoke with the service users who were being case tracked, and other service users and relatives. They informed the inspector that regarding the care, their opinions were; ‘The care is excellent’. ‘There are many frail people here who get well care for’. ‘I cannot fault the care. It is very good’. On examination of the storage of medications, and the medication administration the inspector observed that the storage was satisfactory, and the medication administration records were up to date with all the records signed as appropriate. Qualified nurses administered the medications. Visitors were allowed to visit the service user in the communal areas or in the privacy of their own room. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 11 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): Standards 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Various activities and outings were organised within the home, which would provide stimulation to service users and enhance their quality of life. Service users were given the opportunity to exercise their right of choice regarding the provision of meals. EVIDENCE: The manager informed the inspector that an activities co-ordinator was employed. She was flexible with her duties as her role included arranging activities and mini bus driver. The manager identified that as well as the activities co-ordinator, the care staff also organise activities. An example of this was given, that the staff from India, produced a themed evening where they provided traditional dances as part of the entertainment and traditional Indian food was provided. The inspector discussed the benefits of creating more themed nights covering other cultures and celebrations. The inspector was able to speak with the activities co-ordinator. This individual was enthusiastic about her role, and was clearly interested in providing activities and outing, which would enhance the service users’ quality of life. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 12 The activity co-ordinators produced her records for inspection from the care plans. These records indicated what activities had occurred and who participated in the activity. The activities co-ordinator and manager informed the inspector that a group of service users, and staff had been away to Skegness in the mini bus. Also shorter trips were undertaken for service users who could only travel short distances. The home has its own mini bus, which is frequently used by service users. On discussing the activities with the service users, the inspector was informed that; ‘The activities person keeps those busy, who want to be kept busy’. ‘Activities occur on a one to one basis – like doing my jigsaw’. ‘The staff entertain us’. Regarding the meals, the manager advised the inspector that the service users were offered a choice of meal. The manager provided evidence to the inspector that there was a four weekly menu record. Menu boards were displayed within the dining rooms. The menu displayed on the boards corresponded with the four weekly menu record. The inspector received positive comments from the service users regarding the food. The general comments were that; ‘The food is good’. ‘Always have a choice’. ‘If we don’t like it, they will do us something else’. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 13 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): Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. As far as could be established the service had a complaints procedure in place, which was operating according to the company policy and complaints were resolved within the expected timescales. The home was able to evidence that the staff had received Safeguarding Adults training. Therefore staff would be aware of their responsibility regarding the protection of vulnerable adults. EVIDENCE: The complaints procedure was displayed and available to the service users and relatives. On discussing complaints with the service users, they informed the inspector that they were satisfied with their care. On examination of the complaints file the last recorded entry was for the 09/05/06, which had been resolved. No complaints were addressed to the inspector, at the time of this visit. The Commission had received no complaints since the last inspection. The manager and owners monitored the complaints as part of their quality assurance. Regarding Safeguarding adults training, the manager was able to evidence that the staff had attended the training, more than three yearly. (The Derbyshire County Council Adult Protection Unit had set the three yearly timescale.) Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 14 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): Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The environment, monitored at this inspection, had been maintained to the required standard to provide a safe, well-maintained environment for services users. However there was a concern regarding the window restrictors. EVIDENCE: Whilst touring the building the inspector found that the home was clean, and well maintained, and there had been considerable investment of new double glazed PVC windows in some parts of the home. However the following area required attention. Within Room 10, (Beeches) there was a large darkened area on the carpet, near the bed. The manager advised the inspector that it was a ‘manufacturing fault’ and that the carpet was being replaced. At present the owners were still in discussions with the carpet company, and therefore a specific date could not be provided. The carpet was not worn and was odour free, so no requirement Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 15 was made regarding this matter, but the inspector will monitor the carpet and the progress of the replacement on the next inspection. On examination of the window restrictors on the windows within the purpose built section of the home, (The Poplars and The Willows units) the following was established: When the window was found to be open, the restrictor had locked into position on a pin and limited the opening size of the window. On closing the window the restrictor released from the mechanism and retracted into the housing in the window section. However on re-opening the window, some restrictors remained in the housing section and did not engage with the pin to restrict the opening. Therefore the window could be fully opened. This was of particular concern, with the windows on the first floor. The restrictors which did not engage with the pin had grit and dirt around the housing section. When this problem was brought to the attention of the manager and owner, they acted upon this immediately. The handyman was summoned and requested to clean and oil the restrictors and ensure that the restrictors operate correctly. This intervention was acted upon and completed, before the completion of the inspection process. Also the owners put a safety monitoring system in place, to prevent this occurring in the future. The monitoring system was that when the handyman checked the water temperatures within each room, on a weekly basis, at this time he would also check the window restrictor. Therefore as the problem was acted upon and resolved and a monitoring system implemented, then a requirement was not listed in this report. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 16 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): Standards 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The lack of a robust staff recruitment process regarding the checking of PIN’s for qualified nurses and staff not being up to date with their training may place service users at risks. EVIDENCE: On examination of the rota the following was indicated. Am shift. 3 qualified nurse plus 9 care staff. Pm shift. 3 qualified nurse plus 9 care staff. Night shift. 2 qualified nurse plus 6 care staff. Plus, The manager and activities co-ordinator. Additional staff included: 1 Administrator 2 Dining room assistances 2 Adaptation Staff (providing care, under supervision) 4 Housekeepers 3 Cooks 2 Laundry staff 1 Handyman Caring for 66 service users. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 17 A full assessment of the dependency levels of the service users was not undertaken by the inspector and compared with the indicated staffing levels. On examination of the three staff files, all three contained the required documentation, including Criminal Records Bureau checks, except for the qualified nurse’s file. Within the qualified nurse’s file, the nurse registration document stated that her Registered Nurse Personal Identification Number (PIN) had expired in 2005. The manager was unable to provide any evidence to show that the PIN had been renewed. It was agreed that this nurse would not be on duty to care for service users, until the manager had seen evidence of an up to date PIN. On discussing the verification of the PIN’s, the manager informed the inspector that she photocopied the PIN card, which was proved by the qualified nurse. The Nursing and Midwifery Council (NMC) states that the cards do not guarantee registration, for example: if the NMC removed a nurse from the register, and she was unable to practice as a qualified nurse, the nurse would still have her card. The inspector discussed the NMC Web site, which once the company is registered with the site, is a quick, and easy method of verification of the current statues of the nurse’s registration. The owner and manager agreed to explore this option, and to check all the staff PIN’s on the NMC website. On examination of another staff file, the inspector was shown evidence that the member of staff had received the ‘National Carer of the year award’ for 2004. In relation to training, the manager showed the inspector the training records. These records indicated that as well as the Moving and Handling and Fire training, considerable other specific clinical training had occurred. However on analysing the training records the inspector observed that the records showed that some staff had not received Moving and Handling And Fire Training, over the past twelve months. A discussion occurred regarding staff being requested to attend and then not attending, however it was accepted that the staff need to attend the training and that all the staff will be supervised and up to date with the training within the next two months. The inspector accepted this timescale. The manager and owners identified that the PIN and training issues should be addressed with the appointment of the Deputy Manager, who will be taking responsibility for some of these areas. Throughout the home on all areas, which the inspector examined, from the provision of care from the qualified nurses and care staff to the delivery of service i.e. the provision of food, the maintenance of the building, the Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 18 provision of housekeeping and laundry services, the inspector observed practices and heard comments from and to staff and to and from service users and relatives to be able to establish that there was a clear ethos of teamworking and staff wanting to provide the best care and service that they could provide. The inspector would commend this. This was supported by the positive comments that the inspector received: ‘The staff are excellent and cannot do enough for them (service users)’. ‘Staff are good and kind’. ‘There are a lot of staff from India, who are very caring’. Relating to NVQ training the inspector was advised and shown evidence that over 50 of the staff had achieved level 2 NVQ training, as required in the Standards and NVQ level 2 and 3 training for staff was ongoing. Also the Cooks had obtained Intermediate Food Hygiene certificates. It was recognised that there was a considerable company investment in training, but unfortunate that some staff had not attended the required training. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 19 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): Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The management of the home does comply with the requirements of the Care Homes Act. Extensive quality assurance systems were in place that should assist the manager and owners to measure the home against expected outcomes. EVIDENCE: Within the management structure of the company there was a registered manager who was supported by the owners, who took an active role within the home, and were at the home on a daily basis. The registered manager informed the inspector that she had attained the Registered Managers Award Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 20 On speaking with relatives they identified that the manager and owners often approached them to ask their views and to monitor if they were satisfied with the care and service provision. The manager informed the inspector that she often contacted relatives by telephone to ask if they were satisfied, as part of the quality assurance. On examination of the staff supervision records, the inspector established that staff had received supervision. The standard required supervision to occur six times a year. The manager was on course to achieve this number of supervisions. There were quality assurance and quality monitoring arrangements in place. The Registered Nursing Homes Association (RNHA) quality assurance system was utilised, with a rolling programme of audits undertaken. Findings of Audits, and Customer satisfaction surveys were reviewed at management meetings. The resident personal monies were held within an accounting system. The company managed small amounts of cash for service users. Regarding Standard 38, Health and Safety issues were raised in other sections of the report. Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 21 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement The registered person must ensure that all the qualified nursing staff, employed at the home have a current registration with the Nursing and Midwifery Council. The registered person must ensure that all staff receive training in Moving and Handling and Fire. Timescale for action 17/09/06 2 OP30 18 17/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Morton Grange DS0000002066.V308277.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Morton Grange DS0000002066.V308277.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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