Inspection on 07/12/05 for Pymgate House

This inspection was carried out on 7th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Pymgate House 08/07/08

Pymgate House 19/09/07

Pymgate House 03/05/06

Pymgate House 06/05/05

Pymgate House 18/11/04

Pymgate House 19/05/04

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 Pymgate House 149 Styal Road Heald Green Stockport Cheshire SK8 3TG Lead Inspector Kathleen Mcall Announced Inspection 7th December 2005 10:40 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 Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 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. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Pymgate House Address 149 Styal Road Heald Green Stockport Cheshire SK8 3TG 0161 437 1960 0161 498 9645 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) Mr Brian Fox Mrs. Patricia Fox Mrs. Patricia Fox Care Home 10 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (9) Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 9 OP and up to 1 MD (E). Date of last inspection 6th May 2005 Brief Description of the Service: Pymgate House is situated in the Heald Green area of Stockport. It is a large detached house set in its own grounds. The property dates back to the 1770s, and much of its original character has been retained. Pymgate House is registered to provide accommodation for up to ten older people one of whom may be suffering from a mental disorder. The registered providers of Pymgate House are Mr Brian Fox and Mrs Patricia Fox, who live on the premises. Mrs Fox is actively involved in the day to day running of the home and has hands on approach with the service users. Accommodation includes six single bedrooms and two double bedrooms, one main lounge and a small sitting area off the main lounge and a separate dining room. There are two bathrooms, one on the ground floor, which has a bath hoist to assist service users and a shower. The bathroom on the first floor also has a shower facility. There is a stair lift to assist service users to their bedrooms on the first floor. The home operates a non-smoking policy for service users, visitors and staff. There is a large car park to the front of the house and extensive gardens with a decked area to the rear of the property. The home has three dogs and a parrot. Two of the dogs are registered as patdogs. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place over the course of a day. A pharmacist inspector accompanied the inspector, and assessed the medication management and administration systems at the home. The registered manager accompanied the inspector throughout the inspection process. Care plans, assessment documentation, and other records were examined. The inspector spoke with a number of residents, three members of staff who were on duty and three relatives who were visiting the home at the time of the inspection. Three service users comment cards were returned to the inspector; two cards indicated that residents liked living at the home and one responded that they sometimes liked living at the home. All three cards indicated that they felt well cared for, that staff treated them well and that their privacy was respected. Three service users indicated that they liked the food. Three comment cards indicated that residents knew who to talk to if they had a problem. Two cards expressed a degree of dissatisfaction with the activities on offer and a number of residents told the inspector that they would like more activities to take place. One resident said there wasn’t enough going on in the home in terms of activities. Three relatives comment cards were returned to the inspector; all cards indicated that relatives felt welcome at the home and could visit their relative in private. All three said that they were kept informed of important matters affecting their relative and that if their relative was unable to make a decision they were consulted about care issues. Three cards said that there was always sufficient staff on duty in the home. Overall relatives comment cards indicated that they were satisfied with the care provided. One relative wrote ‘I feel the home and staff are very efficient in looking after my mother-in-law and are very caring towards her needs.’ One relative told the inspector that she did not feel there was enough going on during the day to occupy her mother and that she believed her mother lacked social stimulation. As a consequence of this she regularly took her mother out to social events. She did not feel that she was able to complain directly to the registered manager about this. At the time of the inspection there were no activities taking place. The TV was switched off and no music was playing. Residents were observed sitting in the lounge all day. Care staff on duty did spend time chatting to residents however invariably caring tasks prevented them from spending lengthy periods of time in one to one conversation with residents. Two residents preffered to spend time in their bedrooms and were very self contained in their own rooms. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: It had been a requirement at the previous inspection in May 2005 that care plans must be improved. At the time of this inspection it was observed that there had been little improvement and care plans remained poor, those seen did not provide sufficient detail on what a residents care needs were or how staff were meeting those needs. A number of issues concerning medication storage and recording were found on the inspection by the pharmacist inspector. These included poor record keeping and storage including storage of excessive and out of date stock. This practice puts residents at risk. Residents and relatives complained to the inspector that there was not enough activities taking place in the home. The registered manager must review this and meet the needs of the majority of the residents. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 7 Whilst staff received informal supervision on a daily basis and a staff handover is held at the end of each shift the registered manager has not yet put formal supervision arrangements in place. This is an outstanding requirement from the 19th August 2004. 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. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Service users care needs were fully assessed before admission and they satisfied with the care provided. EVIDENCE: No new service users had been admitted to the home since the last inspection. As part of the inspection a selection of service user files were examined. These contained a sufficient amount of assessment information in respect of each service user. It was the practice of the home that service users were assessed prior to their admission. Assessments were obtained from social workers and health professionals if they had been involved in the admission. Service users told the inspector that they were happy with the way in which the home was meeting their needs. Care staff demonstrated a good understanding of service users care needs. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 10 One relative told the inspector that she felt care staff had a good understanding of her mothers care needs and that she was very satisfied with the standard of care provided. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Care plans did not accurately reflect how service users cares needs were being met. Despite this service users health and care needs appeared to be met. Medication practice was unsatisfactory. EVIDENCE: At the last inspection the home had been given a requirement in respect to service users care plans. The registered manager was required to review all service user care plans and to ensure that the service user care plan illustrated how the home was meeting service users needs in respect of their care and health needs. Since the last inspection there had been no improvement in the standard of care plans and care plans remained poor. The manager had sought advice in developing care plans but had only completed one of the new style care plans. Three others had been started and remained incomplete. Two service users did not have a care plan, as was previously observed at an inspection in May 2005. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 12 Daily records were now completed on a daily basis; previously they had been completed on a weekly or a monthly basis. However daily records contained a limited amount of information and tended to focus on a service users food intake with no mention of the care given to a service user or how they had spent the day. At the time of the inspection a GP was visiting the home. All service users at the home were registered with the GP, who called on a monthly basis and reviewed service users health needs. Service users told the inspector that they found it reassuring that their GP called monthly and if they had any difficulties they knew they would be able to discuss them with him. One relative said she also thought it was a good arrangement and that it worked well for her mother and she found it useful to coordinate her visit when the GP was visiting, if she had any concerns regarding her mothers health. A pharmacist inspector examined the storage and administration of medication at the home. Evidence of poor practice in the storage, recording and administration of medication was found and a number of requirements have been issued. Service users told the inspector that staff treated them well and they were very satisfied with the care they received. Care staffs approach towards service users was observed to be respectful, sensitive and caring at all times. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The day-to-day routine of the home including mealtimes was relaxed and informal and met service users needs. EVIDENCE: The day-to-day routine of the home was relaxed and flexible with some service users preferring to spend time in their rooms and others using the lounge areas. Service users said they could get up and go to bed at times that suited them and that the day was theirs to spend how they choose too. The home did not have a formal activities programme. At the time of the inspection there were no activities taking place. The TV was switched off and no music was playing. Residents were observed sitting in the lounge all day. When time permitted care staff spent time chatting to residents in between completing caring tasks. Two service users preffered to spend time in their bedrooms and were very self contained in their own rooms. One relative told the inspector that she did not feel there was enough going on during the day to occupy her mother and that she believed her mother lacked social stimulation. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 14 Whilst some service user were happy with this arrangement a number of others were not so happy and said that they would like to see more activities taking place and for staff to spend time undertaking activities with them. Visitors were made welcome at the home and service users kept in touch with family and friends. The inspector joined service users for lunch, which was well presented and freshly made. Service users told the inspector that they enjoyed the meals provided at the home; lunch was always a three-course meal with fresh vegetables, the tea time meal was a light snack meal and breakfast was served in service users bedrooms. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users felt confident that their complaints would be taken seriously and acted upon. EVIDENCE: The home had a detailed complaints policy and procedure; there had been no complaints since the last inspection. Service users told the inspector that they knew who to complain to and felt that their complaint would be dealt with in a suitable manner. A complaint was made about the lack of suitable activities on offer in the home; the complainant did not feel that they could directly approach the registered manager about their level of dissatisfaction. The inspector discussed the complainants concerns regarding low levels of activity in the home with the registered manager who agreed to review the situation. The home had a procedure for responding to allegations of abuse. A number of care staff had looked at issues around adult protection and abusive care practices in residential care homes as part of their National Vocational Qualification training, however not all staff had undertaken training in adult protection issues. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 16 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, 24 and 26 The home was well maintained and provided comfortable living accommodation for service users. EVIDENCE: The home provided comfortable accommodation throughout. The grounds of the home were well kept and attractive. The home was clean, tidy, bright and airy throughout and was free from any unpleasant odours. A number of service users rooms were seen, these were also furnished and equipped to a comfortable standard, many had been personalised by the occupants, with many of the service users being quite self contained in there own rooms. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 17 Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 18 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 and 29. The home was sufficiently staffed with a staff group that was trained to undertake their duties. EVIDENCE: At the time of the inspection the home was adequately staffed with a staff group that was trained to meet the assessed needs of service users in the home. The staff group at Pymgate House was a stable one and there had been no new members of staff employed at the home since the last inspection. Recruitment files of existing staff were examined and these were found to hold all relevant documents and photographs of staff employed by the home. 75 of the current staff group held an NVQ qualification. Care staff on duty at the time of the inspection confirmed that they had undertaken further training to assist them in their role as carers these included moving and handling updates, food hygiene and fire training. A safe handling of medicines course was planned for the 8th December 2005. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 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, 36 and 38. The home was well managed for service users; however staff were not appropriately supervised. The health and safety of staff and service users was safeguarded. EVIDENCE: The registered manager does not hold a relevant qualification in care. She is an experienced carer and has held the post of manager at Pymgate House since 1986. At a previous inspection it was observed that the home had made a start in developing a quality assurance and monitoring system. Service users questionnaires had been completed and the results analysed. The registered manager was required to develop this further to include questionnaires being given to relatives, friends and significant stakeholders concerned with the home and that questionnaires must be anonymous. At the time of the Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 20 inspection there had been no further progress with regard to developing the homes quality assurance systems. The home complied with the requirements of the fire authority. The home maintained records in respect of fire safety at the home. Staff had updated their training in safe handling and moving procedures, fire safety, food hygiene and health and safety. The home recorded information in respect of falls and accidents by service users. Since the last inspection the registered manager had undertaken an observed practice of all of care staff. There is still an outstanding requirement from the previous inspection for the registered manager to undertake regular formal supervision for all staff. Staff told the inspector that informal supervision took place on a daily basis at handover between staff. This was an outstanding requirement from two previous inspections. The registered manager had not responded to requirements regarding the supervision of staff within prescribed timescales. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 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. 2. Standard OP7 OP7 Regulation 15(1) 15(1) Requirement The registered person must ensure that all service users have an up to date care plan. The registered person must review all service user care plans and must ensure that the service user care plan illustrates how the service users needs in respect of health and welfare are met. (Timescale of 06/08/05 not met.) The registered person must ensure that the medicines policy is developed and expanded to reflect current guidance issued by the Royal Pharmaceutical Society and comply with the National Minimum Standards. The registered person must ensure that an accurate dated record is maintained of all medication received or disposed of by the home. The registered person must ensure that the MAR charts used by the home are adequate for the purpose and accurately reflect the medication prescribed and administered. DS0000008579.V263079.R01.S.doc Timescale for action 07/12/05 07/01/06 3. OP9 13(2) 07/03/06 4. OP9 13(2) 17(1)(a) 10/01/06 5. OP9 13(2) 13(4)(c) 10/01/06 Pymgate House Version 5.0 Page 23 6. OP9 13 (2) 7. OP9 13(2) 13(4)(c) 8. OP9 13(2) 13(4)(c) 9. OP9 13(2) 13(4)(c) 10. OP9 13(2) 13(4)(c) 11. OP9 13(2) 13(4)(c) 12. OP9 13 (2) 17(1)(a) 13. OP9 13(2) 18(1)(c)i The registered person must ensure that all medication is administered to residents as prescribed. The registered person must ensure that medication provided to residents for use “on leave” is provided in appropriately labelled containers. The registered person must ensure that residents who wish to manage their own medication are assessed as to their ability to do so, before medication is provided to them. Assessments must then be repeated on a regular basis. The registered person must ensure that medication in the custody of the home is stored at the appropriate temperature and humidity. And that it is stored securely and is not accessible to unauthorised persons. The registered person must ensure that all items of medication which have exceeded their expiry dates, do not belong to current residents or are not labelled with prescribed directions are returned to the supplying pharmacy. The registered person must ensure that medication is not removed from its original labelled container prior to administration. The registered person must ensure that the receipt, administration and disposal of controlled drugs are recorded accurately and contemporaneously in a Controlled Drugs register and that any corrections are made by dated marginal note or footnote. The registered person must ensure that all staff members DS0000008579.V263079.R01.S.doc 13/12/05 13/12/05 10/01/06 07/02/06 13/12/05 13/12/05 13/12/05 07/02/06 Page 24 Pymgate House Version 5.0 14. OP12 16(2)(m) (n) 15. OP18 13(6) 16. OP33 24(1)(3) 17. OP36 18(2) employed by the home, with responsibility for medication administration have received appropriate training. The registered person must consult with service users about their social interests and preferred programme of activities to be provided in the home. The registered person must make arrangements for all staff to attend training in adult protection. The registered manager must ensure that feedback from service users is provided through the use of anonymous user questionnaires and that the views of family, relatives and significant stakeholders is sought. (Timescale of 06/05/05 not met.) The registered manager must ensure that persons working at the care home receive formal supervision at least six times a year. (Timescale of 19.08.04 not met). 07/02/06 07/07/06 07/07/06 07/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that the home retains a list of staff members authorised to administer medicines, which includes a record of their signature and approved initials. The registered person should liaise with the supplying pharmacist to ensure that all medication received by the home is labelled on both the inner container and the outer DS0000008579.V263079.R01.S.doc Version 5.0 Page 25 2. OP9 Pymgate House 4. OP9 box. The registered person should ensure that the date of opening is recorded on all items that have a limited shelf life once opened, to ensure that the health of residents is not put at risk by the administration of expired medication. Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Pymgate House DS0000008579.V263079.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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