Inspection on 24/04/06 for Preston Glades Care Home

This inspection was carried out on 24th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Preston Glades Care Home 01/10/08

Preston Glades Care Home 04/09/07

Preston Glades Care Home 09/03/07

Preston Glades Care Home 19/12/05

Preston Glades Care Home 04/08/05

Preston Glades Care Home 23/02/05

Preston Glades Care Home 24/05/04

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 Preston Glades Care Home Miller Road Preston Lancashire PR2 6NH Lead Inspector Phil McConnell Unannounced Inspection 24th April 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Preston Glades Care Home DS0000006072.V288964.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. 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. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Preston Glades Care Home Address Miller Road Preston Lancashire PR2 6NH 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) 01772 651484 01772 651514 None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Valerie Francis Care Home 65 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (34) of places Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Registered Person must employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 65 service users to include: Up to 31 service users in the category of DE (Dementia) Up to 34 service users in the category of OP (Old Age over 65 years) Registered numbers to include one (1) named person under 65 years of age 19th December 2005 Date of last inspection Brief Description of the Service: Preston Glades Nursing Home is owned by, Four Seasons Health Care. The Home is registered with the Commission for Social Care Inspection to provide nursing and personal care to elderly people of both sexes over the age of 65 years. This comprises of 33 service users with dementia and 31 service users with old age in need of nursing and residential care. Preston Glades is a purpose built two-storey building and care is provided in two areas of the home for the two categories of service user. Those needing care regarding dementia are cared for on the first floor of the home, and those needing nursing and personal care on the ground floor of the home. There are 62 single bedrooms of which 16 have en suite facilities and 1 double room. There is a passenger lift to each floor of the home. The home is situated in its own grounds and there is an enclosed garden area at the rear of the home with a pleasant a sitting area. There are parking areas available at the side and front of the home. Preston Glades is located in a residential area of Preston and it is close to local shops and amenities. It is situated on a bus route into Preston town centre. Service users are encouraged to return to their links with the surrounding community and visitors are welcome at anytime. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced which meant that the provider was not aware that the inspection was to take place. The inspection was carried out by two inspectors and took place over a period of seven hours. The focus of the inspection was to review any requirements or recommendations from the last inspection and to assess all of the key standards identified in the National Minimum Care Standards for Older People. The registered manager was present during the inspection and there was the opportunity to speak to some of the service users, staff members, the senior administrator and four visitors. Comment cards had also been received from service users and relatives, containing both positive and some negative comments about Preston Glades. Four service users were ‘case tracked’ which meant that their files were examined and discussions took place with them throughout the inspection. Policies, procedures and staff files were also examined and a tour of the home was undertaken. What the service does well: What has improved since the last inspection? There has been an improvement with the recruitment process, especially in the obtaining of Criminal Records Checks (CRB) and at the time of the inspection all staff had CRB clearance. Some staff changes have taken place since the last inspection and this appears to have had a positive impact on service delivery, for example a new chef had been appointed and there were a number of complimentary comments made during the inspection about how the meals had improved. Although there are still some concerns regarding the environment, it is evident that the home is progressing in aiming to meet the required standards in these areas. Preston Glades Care Home DS0000006072.V288964.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. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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 Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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): 3 Quality in this outcome group is – ‘Adequate’ There is insufficient documented evidence that service users needs and aspirations are assessed. EVIDENCE: The homes policy and procedures for new admissions to the home were present and up to date. Four service users were case tracked’, including two of the most recent admissions to the home and all of their files contained relevant assessment documentation including: admission assessments, care plans, detailed social assessments, dependency rating scale documents, up to date daily record sheets. However, although the assessment tools were present, there was limited information written down, both for service users who had lived there for a while and the newer residents. There were no Social Services assessments in the individual files, which again indicated that there is limited information to ensure that service users assessed needs, are being appropriately met. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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): 7,8,9 and 10 Quality in this outcome group is – ‘Poor’ Service users’ care plans contained sufficient information, in order for staff to provide appropriate health care to individuals. There are systems in place within the home in respect of medication. However, these are not always applied; therefore the medication practices adopted could place residents at risk. EVIDENCE: A new (March 2006) thorough and comprehensive Care Manual was in place,incorporating all the relevant policies and procedures, giving the necessary information to provide a good standard of care. A Dementia Care Manual (March 2006) was also available for examination,which included good and specific information to provide care to people who have dementia, for example; ‘Philosophy for the care of people with dementia’, ‘Well-being profiling’ (put ourselves in the shoes of a person with dementia), a section on ‘Pain assessment’ for the cognitively impaired and Fall risk assessment for older adults. The manual also focuses on the use of a sensory room for dementia care and has a section about Consent and Best Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 10 interest decisions,saying that service users should be included, when possible in all decisions about their care. The service users files that were examined contained evidence that monthly medication reviews are held and one service usersfile referred to them having their ears syringed and another gave up to date information regarding a pressure sore assessment (using a recognised scoring system). An appropriate mattress had been aquired to help with the treatment of pressure sores, this highlighted that service users health needs are monitored, reviewed and action taken when needed. The current medication administration records (MAR) were examined for both floors of the home. It was noted on the ground floor that the recording of administration was not always accurate. The use of the key coding system at the bottom of the MAR was not consistent leaving the records unclear and ambiguous on several occasions. The manager is advised to develop this key code system further to ensure any non-administration is clearly explained. Handwritten records were in place for one person, but were not completed accurately. Signature omissions without explanation were noted with medication being given from the monitored dosage system. The above errors indicate staff relying heavily on the monitored dosage system, therefore not following the correct administration procedures, namely referring to the medication administration record whilst assembling the medication and signing the record immediately after witnessing the resident taking it. The manager is advised to take appropriate steps to ensure all staff members understand their responsibilities in administering and recording medication as prescribed by the GP. Two residents had not received medication due to the item not being in stock at the home, two days had elapsed since the delivery of the medication and this should have been rectified. The pharmaceutical fridge was temperature monitored with the majority of it’s contents being signed and dated upon opening, however one bottle of eye drops remained in use after it’s recommended period of use. The recording of returns was generally accurate with a dedicated book, with each returned item documented, with the signature of the pharmacist or district nurse accepting the returns. The home has good storage and a register in place for controlled drugs. Medication on the first floor of the home was well managed with good records being maintained. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 11 The manager of the home was advised that the colour coding of the MAR sheets on both floors was not consistent with the colour of the medication trays which could lead to confusion and mistakes being made. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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 and 15 Quality in this outcome group is – ‘Poor’ Social and leisure activities need to be improved, with a more structured and planned recreational and activities programme in order for people to be motivated and stimulated. All service users should be given the opportunity to access the community, to promote community participation and social inclusion. EVIDENCE: Since the previous inspection the activities organiser had left and in speaking to service users and staff, there are few activities taking place within the home. One service user commented, it is really boring here, there is nothing to do Six service users and one staff member were observed playing dominoes after lunch and there was some evidence that the service users in the dementia unit have recently become more involved in varied activities and interests. In discussion with service users and staff members, there is little evidence that service users have the opportunity to venture outside of the grounds of the home, unless a relative or friend is able to accompany them. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 13 People need to be encouraged and motivated to maintain interests and be involved in meaningful activities in order to provide stimulation and meet their needs. Some staff were observed interacting with visitors and they demonstrated a professional and caring manner. The home has an open house visiting policy and during the inspection, discussions took place with a number of visitors and they confirmed they are able to visit at any reasonable time and are always made welcome by the staff, indicating that contact with service users relatives and friends is maintained and encouraged. There was evidence that service users are able to make choices, for example, one service user said I like to have my meals in my room and I can make that choice and staff were seen to take meals to service users in their own rooms if they did not wish to eat in the dining area. In discussion with service users and in observing their bedrooms, it was clear that people are encouraged to take personal belongings into the home, reflecting their own choices and individuality. The mid-day mealtime was observed in both of the dining rooms, (upstairs and downstairs) they were unhurried and when necessary people were supported to eat their meals, which was done sensitively and respectfully in pleasant surroundings. The meal was seen to be well cooked and well presented. Some of the comments in relation to the meals included:we have a new chef and he is quite good, he made a really good hotpot with a crust and the food has really improved now that we have a new chef, the meals are very good”. Some less able service users were observed being assisted to eat their meals in their own bedrooms. Helping to demonstrate that people’s individual needs are being met. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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 and 18 Quality in this outcome group is – ‘Good’. The policies and procedures for dealing with complaints and allegations / suspicions of abuse were thorough and detailed, helping to protect vulnerable adults. EVIDENCE: There was a thorough and adequate complaints policy and procedures in place for dealing with a complaint, which had recently been reviewed and updated (March 2006) In discussion with members of staff they were fully aware of complaint procedures. There was also the opportunity to speak to relatives / visitors and they were also aware of how to make a complaint if they were unhappy about anything. Some of the comment cards returned from relatives indicated that they were unsure of how to make a complaint.However there is a notice in the homes entrance giving clear guidance of how to make a complaint. There was a policy with robust procedures in place, to ensure that service users are protected as much as possible from any form of abuse. All members of staff have had Criminal Record Bureau Checks, (CRB) helping to safeguard that only appropriate people are employed to support and care for vulnerable adults. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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 and 26 Quality in this outcome group is – ‘Adequate’ There was an overall improvement in the cleanliness and hygiene of the home; however, there are still some environmental concerns, which need addressing. EVIDENCE: A tour of the home was completed and many of the concerns regarding repairs and cleanliness, that were raised at the previous inspection had been addressed. There are still some areas of the home that are in need of redecoration, along with some repairs and good practice issues. Areas of the building, which are advisable to keep locked, were not, and it was observed that some of the ‘emergency pull cords’ were out of reach of service users. These issues were discussed with the manager, following the inspection. It was very hot in the home during the inspection and it was apparent that there was a problem with the heating system. A number of the radiators are still not covered or thermostatically controlled, which could cause potential harm to service users Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 16 The manager informed the inspectors that a full service of the heating system will be carried out during the summer and there were notices placed around the building apologising for the excessive heat and informing service users and visitors about the planned overhaul of the heating system. There had been two visits from the Environmental Health since a caution was issued by them on the 23/01/06. Correspondence was observed stating that there had been an improvement in the hygiene and cleanliness of the premises, especially the kitchen area, indicating that the provider is working with other professional bodies to improve the environment for service users and staff. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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 and 30 Quality in this outcome group is – ‘Good’ The staffing levels are adequate to meet the needs of the service users. There is a robust and thorough recruitment process, helping to safeguard and protect service users. EVIDENCE: Staff files, rotas and training records that were examined, highlighted that there was a mixture of suitably qualified and skilled staff with sufficient staffing levels employed in the home. In observation and discussion with staff members, there was a clear indication that staff work together to meet the needs of the service users. There had been some recent staff changes, which appear to have had a positive impact within the home, one visitor commented “I love coming here now, it’s so much better now there has been a change in the staff, they are more friendly than previous” and some service users said, “the care staff are really good” and “the ‘girls’ are excellent” There was a comprehensive recruitment procedure in operation with staff files showing that correct procedures had been followed for individuals, including: two written references and Criminal Records Bureau (CRB) checks being made Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 18 prior to commencing employment, ensuring the protection of service users wherever possible. Training records showed that staff had received mandatory training in moving and handling, fire safety, first aid, food hygiene, and infection control. All of the staff have either achieved the National Vocational Qualification award level 2 (NVQ) or are in the process of obtaining it, with some of the senior carers having passed their level 3.This helps to demonstrate that the provider is committed to have adequately trained staff, with the aim to provide good care to service users. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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): 31,33,35 and 38 Quality in this outcome group is – ‘Adequate’. An appropriate management structure is in place, helping to ensure quality care to service users. Health and safety issues (see environment) are still causing some concerns EVIDENCE: The registered manager has many years of experience in the care of older people and during her time at Preston Glades a number of positive changes and improvements have been made. In discussion with staff it was commented, “the manager is approachable” another said, “I wouldn’t hesitate to go to the manager, she is always fair”. The home has once again maintained the quality assurance award, after being reassessed by ‘The Residential and Domiciliary Benchmarking Company’ Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 20 (Quality assurance monitoring agency) and the report stated. “The home has a structured performance management system in place to support development and manage staff performance” and “The home is alert to the need to assure the quality of its service delivery”. Services users’ financial records were examined and they were up to date and accurate. The financial system is clear and robust, thereby helping to protect and safeguard service users financial interests. The training matrix was inspected in conjunction with staff files and there was documented evidence that staff have received relevant and appropriate training, including: moving and handling, protection of vulnerable adults (POVA), infection control, fire safety training, first aid, food handling and customer care. In discussion with some of the staff they said, “the training is very good” and “we are always learning new things to help the residents” There was an up to date health and safety policy, with comprehensive risk assessments, promoting the health and safety of service users. All inspection certificates were in place and up to date, including: gas safety certificate, electric check certificate, fire extinguisher checks, and emergency lighting certificates. However, as previously mentioned there are some environmental concerns, which could affect the safety and protection of service users. Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP19 Regulation 23 Requirement The environmental standards must be improved. (Previous timescale 19/12/05 not met) All Radiators must be guarded or fitted with temperature controlled devices. (Previous timescale 31/01/06 not met) Call bells must be placed in reach of residents. (Previous timescale 19/12/05 not met) The registered person must ensure all medication is administered as prescribed. (Previous timescale 28/02/06 not met) Timescale for action 24/07/06 2. OP25 23 24/07/06 3. OP23 23 01/06/06 4. OP9 13(2) 01/06/06 Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 23 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 OP30 OP9 OP9 Good Practice Recommendations All documents should be fully completed and signed All medication packaging should be dated upon opening. The medication audits currently used should be reviewed and updated to ensure staff are administering medication as prescribed. Patient information leaflets for all medicines should be made available and used effectively. The recording of the non-administration of medication should be clearly recorded using the key code system. 4. 5. OP9 OP9 Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Preston Glades Care Home DS0000006072.V288964.R01.S.doc Version 5.1 Page 25 - 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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