Inspection on 12/02/07 for Pinetum Nursing Home

This inspection was carried out on 12th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Pinetum Nursing Home 06/01/06

Pinetum Nursing Home 03/08/05

Pinetum Nursing Home 16/12/04

Pinetum Nursing Home 08/06/04

Pinetum Nursing Home 11/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Pinetum Nursing Home Valley Drive Countess Of Chester Health Park Liverpool Road Chester Cheshire CH2 1UA Lead Inspector A Gillian Matthewson Unannounced Inspection 10.00 12 February 2007 th 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 Pinetum Nursing Home DS0000018814.V315208.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. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinetum Nursing Home Address Valley Drive Countess Of Chester Health Park Liverpool Road Chester Cheshire CH2 1UA 01244 380731 01244 380789 manager.pinetum@careuk.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) Community Health Services Limited Ms Anne Hughes Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (5) of places Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 48 service users including:* Up to 48 service users in the category of OP (Old age, not falling within any other category) * Within the maximum of 48, up to 5 service users may be in the category of PD (Physical disability) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidance which may be issued through the Commission for Social Care Inspection 6th January 2006 2. 3. Date of last inspection Brief Description of the Service: The Pinetum Care Home provides nursing care and accommodation for up to 48 older people and up to 5 people over 48 years of age with a physical disability. The Pinetum Nursing Home is a detached, purpose built property situated within the grounds of the Countess of Chester Health Park near to the centre of the city of Chester and local shops and amenities. There is good access to public transport. The home was first opened in 1991. Bedroom accommodation is provided in single rooms that have hand washbasins. There are no en-suite facilities. Bedrooms are on two floors with a passenger lift and staircases to both levels. There are two main communal lounge areas with two additional sitting areas and a dining room on each floor. Fees range from £500 to £600 per week. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on 12th February 2007 and lasted eight hours. The visit was carried out by one inspector. This visit was just one part of the inspection. Before the visit the registered manager was asked to complete a questionnaire to provide up to date information about services in the home. Questionnaires were also made available for residents, families and health and social care professionals to find out their views. Other information received since the last key inspection was also reviewed. During the visit various records and the premises were looked at. A number of residents and relatives were also spoken with and they gave their views about the service. Comments were positive. One relative said “Staff are always welcoming, helpful and cheerful. My mother is always clean and comfortable”. Another said “ Staff are approachable and listen to concerns and act on them. Carers are made to feel welcome”. Feedback was given to the Registered Manager immediately following the inspection. What the service does well: Prospective residents are assessed prior to admission to ensure that the home can meet their needs, and provided with written information to help them make a decision about whether the home is right for them. The home promotes equality by treating people as individuals and ensuring their diverse needs are addressed through the care planning process. Residents are consulted about their care plans and provided with a good standard of care. They are treated with respect and their privacy and dignity are maintained. Residents are able to make choices in their daily lives and are offered a range of social activities and a well balanced diet. They can receive visitors and go out whenever they wish. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 6 The home has a full complement of appropriately skilled staff. Residents like the staff and feel they work hard to meet their individual needs. There are good systems in place to protect residents from harm. There are good quality assurance systems in place to measure the home’s success in meeting its aims and objectives. 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. Pinetum Nursing Home DS0000018814.V315208.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 Pinetum Nursing Home DS0000018814.V315208.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): 1 & 3. Standard 6 is not applicable. Quality in this area is good. This judgment is based on evidence available at the time of the inspection. Prospective residents are assessed prior to being offered a place, to ensure that the home can meet their needs and are provided with written information to help them make a choice about whether the home will suit them. EVIDENCE: The home has a statement of purpose and service user guide that provides residents with information about the services and facilities the home provides and other useful information such as the arrangements for residents to engage in social activities and religious services and visiting arrangements. Residents spoken with were able to show that they had a copy in their room. All residents are assessed by either the manager or her deputy prior to their admission to the home. The pre-admission assessment covers all the areas necessary to find out what care the resident will need. Residents confirmed someone from Pinetum had come to see them before they were offered a place Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 9 in the home and discussed their needs and how the home could meet those needs. The home also obtained copies of any other health or social care assessment that had been carried out to make sure they had a comprehensive picture of the resident’s needs. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this area is excellent. This judgment is based on evidence available at the time of the inspection. The health and personal care provided is based on residents’ individual needs. The principles of respect, privacy and dignity are put into practice. EVIDENCE: Each resident case tracked had plans of care, which were based on a full needs assessment. Care plans set out the actions needed to meet the diverse nursing and personal needs of each resident. These were comprehensive and had been regularly evaluated to ensure that the nursing actions were achieving the desired outcome. Residents and relatives confirmed that they had been consulted and were involved in the care planning process. Residents were referred to other health care professionals as necessary. One relative said that her mother had been referred for assessment for a new wheelchair. Care records showed that advice had been obtained from continence advisers, tissue viability nurse specialists, speech and language therapists and others. All those residents who were case tracked had had Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 11 regular visits from their GP. Five health and social care professionals completed comment cards and all said they thought Pinetum provided good care. Medication arrangements were reviewed and found to be satisfactory. There was evidence that residents received their medication in accordance with their doctor’s prescription. There were records of receipt, administration and disposal. A stock check of controlled drugs was carried out and found to be correct. Storage arrangements were satisfactory. Observations of staff during the inspection and discussions with residents confirmed that staff were careful to maintain residents’ privacy and dignity and treated them well. The staff induction programme included instruction on how to treat residents with respect. Residents had access to a telephone for use in private and some residents had a private line in their own room. They received their mail unopened. Whilst the inspection was being carried out relatives of a deceased resident came to thank the manager for the consideration and kindness that had been shown to them and their relative. They hugged the manager and said “He couldn’t have had better care anywhere.” Another gentleman also came to the office to say his relative had enjoyed a spell of respite care at the home and to arrange for another stay. At the last inspection it was noted that staff were slow to answer call bells. At this inspection call bells were answered promptly and residents and relatives said that they were answered fairly quickly and they were just occasionally kept waiting at busy times such as mealtimes. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this area is good. This judgment is based on evidence available at the time of the inspection. The home is conducted so as to help residents exercise choice and control over their lives. EVIDENCE: Residents confirmed that they were able to exercise choice in relation to their activities of daily living. For example, they could choose what to eat, where to spend their time and when to get up or go to bed. The home has an activity coordinator who meets with residents to find out what their interests are. These are recorded in the care records and an individual weekly activity plan devised. She also produces a weekly plan of activities that any resident can join in. On the day of the inspection some residents were talking with staff about love and making Valentine cards. The following day the hairdresser was visiting the home and the activity coordinator was going to provide pampering sessions with manicures and hand massage. A spiritual day was planned for Thursday with prayers and poems, indoor games on Friday and an afternoon tea on Saturday for residents and visitors. Residents spoken with said they thought the home provided enough for them to do and one said the home also brought in entertainers, which she enjoyed. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 13 Residents are actively encouraged to keep in contact with family and friends. One resident said she often uses Dial-a-Ride to go out and visit one of her relatives. Several relatives visited the home during the inspection and they said that they could have a meal or a drink while they were there if they wished. Residents could entertain visitors in their room if they wished. The home focuses on the rights of the resident and clearly records if a resident does not want a particular person to visit. Residents have ownership of their room and are encouraged to bring in their own familiar possessions, such as small pieces of furniture, pictures and ornaments. They are encouraged to be responsible for their own money as long as they wish. The administrator gives help when needed, for example paying money into a resident’s bank account. The home will also refer residents to Age Concern if they need an independent advocate. Residents and relatives spoken with said the food was good and there was plenty of variety and choice. Residents can have cereal and toast or a cooked breakfast, a choice of two main meals at lunchtime with a sweet and a lighter hot meal in the evening with a sweet. Other choices are available, such as sandwiches, salads, omelettes, baked potatoes, something on toast. Residents said that they could have anything they wanted within reason. Food is available to meet the needs of all residents, including those on special diets or who have chewing and swallowing difficulties. Drinks are served on a regular basis. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this area is good. This judgment is based on evidence available at the time of the inspection. Residents have access to a robust, effective complaints procedure. Staff have knowledge and understanding of adult protection issues, which protects residents from abuse. EVIDENCE: The home has a satisfactory complaints procedure that is displayed in every room and included in the service user guide. Residents and relatives spoken with were all aware of it. The home had received 6 complaints in the last year. Five had been resolved and 1 was ongoing. There were no themes. The home also had a suggestion box in the foyer. There are appropriate policies and procedures in place in relation to adult protection and whistle blowing. Staff training on induction includes abuse awareness and this is followed up with more in depth training. Staff were undertaking refresher training at the time of the inspection. All staff had undergone Criminal Records Bureau (CRB) checks. Senior staff are aware of when to make a referral under the locally agreed adult protection protocol. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 25 & 26. Quality in this area is adequate. This judgment is based on evidence available at the time of the inspection. The home provides a comfortable and clean environment for residents. Systems are in place to control the spread of infection. EVIDENCE: The home is purpose built and all areas are accessible to residents, including wheelchair users, apart from the kitchen and laundry. There are also accessible outdoor sitting areas. A programme of routine maintenance and renewal of the fabric and decoration of the premises is in place. One bedroom was being redecorated at the time of the inspection. Another bedroom had some plaster damage to the walls that had been caused by the bed. This was unsightly and was pointed out to the manager. She said she would arrange for the room to be redecorated. Although the tables in the dining rooms were attractively set with tablecloths, Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 16 napkins and a fresh flower arrangement, there were no curtains at the windows. This made the downstairs dining room in particular appear cold and uninviting. Routine maintenance checks had identified that the water mixer valves in the bathrooms were failing and required replacement. The manager had notified the Commission and the bathrooms were kept locked unless a member of staff was present to test the water temperature before a resident had a bath. Quotes had been obtained for replacement of the valves and the manager was awaiting a decision from the finance department to arrange for the work to be done. Adequate aids and equipment were provided to meet the needs of the residents. Equipment was regularly serviced and maintained. One hoist had been identified as needing replacement. The manager said this had been agreed in this year’s budget and would be replaced. The home was clean and tidy at the time of the inspection. The laundry, hand washing and sluicing facilities were satisfactory. There were policies and procedures in place to assist with the prevention of cross-infection and staff received training in infection control. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this area is excellent. This judgment is made based on the evidence available at the time of the inspection. Staff in the home are trained, skilled and in sufficient numbers to meet the needs of the residents. EVIDENCE: On the day of inspection there were 39 people in residence. Up to 15 of the beds are used for continuing health care and up to 5 for respite care. Staffing consisted of three registered nurses and seven care assistants in the morning, three registered nurses and six care assistants in the afternoon and evening, and two registered nurses and three care assistants at night. The home also takes student nurses on clinical placement. The home has sufficient permanently employed staff and does not currently use any agency staff. The home employed 28 care assistants at the time of the inspection. Thirteen of these (46.4 ) had achieved NVQ Level 2 or 3 in Direct Care and 11 more (45 ) were undertaking training. Staff files showed that all the necessary checks are carried out on staff prior to employment. These include checks on identity, qualifications and experience, two written references and a Criminal Records Bureau disclosure. Interview records are made. The roles and responsibilities of staff are clearly set out in their job descriptions. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 18 All staff undergo a full induction on commencement of employment that covers all the Skills for Care induction standards. Staff must achieve 100 in tests on a computer programme to complete their induction. The home is also a member of the Cheshire Nursing Home Training Consortium and staff are able to access clinical training on a regular basis. Staff are given on average 5 paid days training per year. Pinetum Nursing Home DS0000018814.V315208.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): 31, 32, 33, 35 & 38. Quality in this area is good. This judgement is based on evidence available at the time of the inspection. The home is well managed with effective quality assurance systems in place that are based on seeking the views of the residents and their representatives. EVIDENCE: The manager is a first level registered nurse with considerable clinical and management experience. She ensures that staff follow the company’s policies and procedures and communicates with the staff team through training, supervision and staff meetings as well as being present around the home on a daily basis. Residents and relatives knew who she was and said she was very approachable. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 20 Clinical governance audits are carried out by the company’s clinical governance officer. Monthly figures are sent to the clinical governance department in relation to staff turnover, training, bed occupancy, financial performance, accidents and incidents, infections and pressure sores. The manager and deputy carry out monthly audits on medication, care plans and health and safety. Regulation 26 visits are carried out on a monthly basis and reports submitted to CSCI. Policies and procedures are reviewed annually in October and updated as required. Customer satisfaction surveys are left out for residents and relatives to complete. The manager had also conducted a customer satisfaction survey in November and the results were very positive. She was about to compile a report detailing service user involvement in the running of the home in 2006. The home holds small amounts of spending money (up to a maximum of £100) for some of the residents. A balance sheet is maintained for each resident, which documents all deposits and withdrawals and a running balance. Receipts are given for all deposits and signatures obtained from the resident or their representative for all withdrawals. All staff receive training in safe working practices that includes moving and handling, fire safety, first aid and food hygiene. Hazardous substances are stored safely and equipment is regularly serviced and maintained. Eight fire drills had been carried out in the last year. All residents had risk assessments in relation to moving and handling but since the home had moved to computerised care records residents who had bedrails affixed to their bed did not have a risk assessment in place for their use. Staff had identified the risk that necessitated a resident needing bedrails, but not the risks associated with their use or control measures needed to minimise the risk. When this was pointed out to the manager she said she would revert to the paper based risk assessment for bedrails until a computerised one was devised. Pinetum Nursing Home DS0000018814.V315208.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X X 2 3 STAFFING Standard No Score 27 4 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 X X 2 Pinetum Nursing Home DS0000018814.V315208.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. 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. 3. Refer to Standard OP19 OP22 OP38 Good Practice Recommendations Provide curtains in the dining rooms to make the environment more pleasant and inviting and redecorate the bedroom identified. Replace the hoist identified as requiring replacement and the water mixer valves as soon as possible to eliminate risk of the hoist failing or residents being scalded. Devise a risk assessment for bedrails to be incorporated into the computerised care records system. Pinetum Nursing Home DS0000018814.V315208.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Pinetum Nursing Home DS0000018814.V315208.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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