Inspection on 03/02/06 for Red House Residential Home

This inspection was carried out on 3rd February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Red House Residential Home 04/06/08

Red House Residential Home 06/06/07

Red House Residential Home 15/06/06

Red House Residential Home 11/04/05

Red House Residential Home 15/11/04

Red House Residential Home 14/04/04

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

CARE HOMES FOR OLDER PEOPLE Red House Residential Home 236 Dunchurch Road Rugby Warwickshire CV22 6HS Lead Inspector Michelle O`Brien Unannounced Inspection 3rd February 2006 10:50 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 Red House Residential Home DS0000004285.V282497.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. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Red House Residential Home Address 236 Dunchurch Road Rugby Warwickshire CV22 6HS 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) 01788 817255 01788 817255 Pinnacle Care Ltd Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. No wheelchair users are to be accommodated in rooms 19, 20 and 21. Date of last inspection 11th April 2005 Brief Description of the Service: The Red House Care Home is located approximately one mile from Rugby town centre. It is a converted detached domestic dwelling set back off the main Dunchurch Road. It provides long-term residential care without nursing for twenty-two frail older people and one younger adult, (under 65years of age) including dementia care. Service users who require nursing attention receive this from the Community nursing service, as they would in their own homes. Accommodation is provided on two floors and consists of seventeen single and three double rooms. En-suite facilities are available in some bedrooms there are also two assisted baths and four communal toilets. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection of the inspection year (April 2005 – March 2006) and was unannounced. The inspection took place over 8 hours commencing at 10.45am. The focus of this inspection was to assess the standards not assessed during the previous inspection and to review the home’s progress in meeting the requirements made. For a full overview of the home this report should be read along with the inspection report of 11th April 2005 On the day of inspection there were 21 residents being cared for in the home; it was the assessment of the acting manager on the day of inspection that two thirds of the residents had low dependency needs and one third had medium or high dependency needs. The inspector had the opportunity to meet several residents by spending time in the communal lounge and spoke with ten of them about their experience of the home. Some of the residents were articulate and able to express their opinion of the service they received to the inspector. Some of the residents found it difficult to engage in conversation due to their dementia but were able to express their feelings with verbal and non-verbal communication. General conversation was held with other residents along with observation of working practices and staff interaction with residents. The inspector was present during the midday meal and joined residents for their evening meal. Documentation maintained in the home was examined and this included care files of residents, staff training records, policies and procedures and records maintaining safe working practices. The acting manager was present during the inspection and co-operated fully with the inspection process. What the service does well: The service provides a homely environment with a welcoming atmosphere. Staff spend a lot of time with residents and support them to participate in meaningful activity. Staff were observed to be kind and caring and showed a good understanding of residents’ psychological needs. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Red House Residential Home DS0000004285.V282497.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 Red House Residential Home DS0000004285.V282497.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): Standards 1 and 3 were assessed. Prospective residents are provided with information to enable them to make an informed choice about where to live and have their needs fully assessed before admission to the home to ensure that their needs can be met by the home. EVIDENCE: The home has produced a Service Users’ Guide and Statement of Purpose. Copies of these were available in the reception area of the home. Evidence was seen that residents are provided with contracts of terms and conditions of residency, including fees to be paid, which are signed either by the resident or their relative. The home has a thorough pre admission assessment process to identify the needs of residents to ensure the home can meet the needs. The assessment process gives consideration to health, personal and social needs. All relevant information was found to be collected in the care files of three residents examined. The information gathered during the assessment process is used to develop care plans for residents; however, it was found that care plans were not implemented for all of the residents’ identified needs. Red House Residential Home DS0000004285.V282497.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): Standards 7, 8 and 10 were assessed. Residents’ care plans do not contain the necessary information to meet all of the identified needs of residents and are not consistently updated when there is a change in need. This puts residents at risk of not having all of there needs met. Regular review of the potential risks to residents’ health is necessary to protect them from harm. Staff treat residents with respect when attending to their needs but the poor appearance of residents does not uphold their dignity. EVIDENCE: The inspector spent two hours in the large communal lounge and observed working practices and staff interaction with residents. Some of the more dependent residents looked unkempt with dirty fingernails, stained clothing and food debris around their mouths. Some of the less dependent residents were well groomed. Residents were not left alone in the lounge for any length of time; a member of the care staff was always present and responded to residents’ needs when required. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 10 Staff were observed to have good relationships with residents and were particularly aware of their psychological needs. Staff spoke to residents respectfully and were observed to knock on the doors of their rooms before entering. Reassurance was given to anxious residents and several agitated residents responded to intervention from staff. Many of the residents were engaged in meaningful activity and there was evidence of psychological well being among residents, despite their dementia. The care files of 3 residents were examined and the inspector met and spoke with all 3 of these residents. Care plans had been written to address some, but not all, of the residents’ needs. It was pleasing to note that the care files contained detailed ‘Personal Profiles’ of residents. It was evident that families and friends had been involved in collecting information such as hobbies and interests, previous occupations, important relationships and life histories. The care plans were found to contain little detail of the actions necessary to meet the needs of residents and most of the information gathered during assessment was repeated. Consequently, although care plans identify needs, they do not give direction to staff on how to meet the need. Information in the care file of one resident indicated that she was admitted to the home with pressure sores to both heels and although the resident was visited by the community nursing service there was no care plan to direct staff how to relieve pressure to prevent further tissue damage. A risk assessment tool for pressure sores (tissue viability) is not used by the home. Statements about each residents’ well being are recorded daily by staff and although changes in care needs are identified and documented there is a lack of care planning for new or changed needs. Although the home uses risk assessment tools for moving and handling, falls and nutrition, these are not used effectively in the development of care plans. The moving and handling plan for one resident identified that a hoist was required to move him because of his inability to weight bear yet there were manual handling instructions for staff to move him when he had a bath as the hoist could not be manoeuvred in the restricted space of the bathroom There was evidence that residents are weighed monthly. Weight loss was documented in two of the residents’ care files but no action was taken to investigate the weight loss or care plans implemented to prevent further weight loss. The inspector was informed that the scales used to weigh residents are transported from another location each month and the accuracy of the scales was questionable because of discrepancies in residents’ weight. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 11 Care files documented that residents have been seen by the optician and are supported to attend hospital outpatient appointments. One of the care files examined contained evidence that relatives attended a review of the residents care and agreed the care plans with staff. Red House Residential Home DS0000004285.V282497.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): Standards 12 and 15 were assessed. Residents are encouraged to engage in meaningful stimulation, which has a positive effect on their mental well-being. Meals provided are varied and provide a balanced diet for residents. EVIDENCE: The personal profile of each resident documents their likes and dislikes, hobbies and previous occupations. There is not a planned activity programme but staff initiate activities daily and this is recorded in an activities diary. On the day of inspection residents were observed to be engaged in meaningful activity. A small group of residents participated in some needlework and knitting, one resident read the newspaper with a member of staff and discussed current affairs and another resident pottered about the lounge singing happily. One resident was very busy folding and sorting laundry. She said she enjoyed this domestic task and it made her feel useful. There was art and craft work on the walls of the dining area which residents had made for St Valentine’s Day. Staff were supportive of residents’ chosen activities and residents seemed happy and cheerful. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 13 Cups of tea and coffee were offered to residents frequently during the day. The inspector was present during lunch, which was served at 12.30pm. Residents were encouraged to attend the dining area for lunch. Some residents required physical assistance to eat and some residents required prompting to eat. One resident found it difficult to sit at the table for any length of time. Staff gave discreet and appropriate assistance to all the residents and making the mealtime a social and enjoyable experience for residents. Afternoon tea was served to residents with cream cakes. The evening meal was served at 5.30pm and the inspector joined residents for the meal of quiche, chips and salad. Residents made positive comments about the food they received. A choice of meal is always available for residents. The inspector visited the kitchen. A good stock of quality food was seen. The most recent Environmental Health Officer’s inspection of the kitchen in July 2005 identified ‘very good standards and practices’. Red House Residential Home DS0000004285.V282497.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): Standard 18 was assessed. The service has systems in place to protect residents from the risk of abuse, increasing their feeling of safety and their quality of life in the home. EVIDENCE: The home has developed and implemented a policy for identifying and responding to suspicions or allegations of abuse and this contains clear guidance for staff. 14 staff have attended training in the protecting vulnerable adults from abuse. It was evident through discussion that the acting manager was aware of her responsibilities in the protection of vulnerable adults and was familiar with local social services policies. The inspector was informed that no referrals have been made to the POVA register. Red House Residential Home DS0000004285.V282497.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): Standards 19, 24 and 26 were assessed. The environment is generally untidy and dirty in places which reduces the quality of life for residents. EVIDENCE: The inspector toured the entire home with the acting manager, spent time in the communal lounge and dining area and visited all of the bedrooms. One of the residents took the inspector to her room and was pleased with the facilities provided. All of the bedrooms were personalised with resident’s own belongings such as photographs, some small items of furniture and soft furnishings. One resident had provided his own double bed. On entering the main lounge inspector noted that a large amount of faecal matter was on the carpet and it was 30 minutes before a visitor pointed it out to staff before it was cleaned. Furniture in the large lounge was comfortable and although several of the chairs appeared quite new some of the armchairs looked shabby and worn. Chairs and settees were grouped in a homely fashion allowing residents to interact with each other and their visitors. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 16 The occasional tables in the lounge were dirty and sticky. The conservatory area was tidy and one resident was seen using this quieter area. It was informed that the home employs cleaning staff for 20hrs each week. Trip hazards were observed on the carpet in one of the corridors and it was informed that this had been caused by recent water damage. The laundry is small and disorganised and the previous requirement to make the walls and floor impermeable and washable has not been addressed. Protective clothing such as gloves and aprons was available for staff. Red House Residential Home DS0000004285.V282497.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): Standards 28 and 30 were assessed. Staff were observed to be competent to do their jobs and have planned training which could result in appropriate care being given and an increase in the quality of life for residents. EVIDENCE: Among the 15 care staff in the home, four members of staff have a National Vocational Qualification (NVQ) in Care at level 3 and two members of staff have an NVQ at level 2. Therefore 40 of care staff are qualified to NVQ level 2 or above which is below the minimum standard for 50 of care staff to be qualified. The home has an induction programme for new staff that includes foundation training in caring skills. The induction booklets of two recently employed staff were seen. The home has a planned training programme that includes mandatory training and other training specific to the client group. This enhances the knowledge and skills of staff caring for residents. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 36 and 38 were assessed. The acting manager of the home is competent to guide staff to ensure residents receive consistent quality care. EVIDENCE: The acting manager has been in post for two years. She has applied to the Commission for registration and is to be interviewed on 24th February. She has experience in care of the elderly but has no previous specialist dementia care experience. She has a HNC in Care Management, a Diploma in Welfare Studies and is halfway through the Registered manager’s Award (NVQ Level 4). There are clear lines of accountability in the home and the management structure consists of the manager, deputy manager and team leaders. There is evidence of some monitoring and audit of working practices within the home. The area manager and acting manager audit medication, staff files, maintenance and care plans. The last survey of residents’ opinion of the service was made in 2004. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 19 The need to develop a method of quality assurance that monitors the home’s performance against the National Minimum Standards was discussed with the acting manager. This will ensure that shortfalls or improved practiced can be identified and action planned appropriately. The process of supervising care staff has begun but is still inconsistent and not in any regular pattern. Staff need to have formal supervision six times a year to ensure that their development needs are met and that residents are cared for by competent staff. Records were examined to establish safe working practices within the home. These included contracts and servicing documentation for electrical equipment, gas, clinical waste and all other services supplied to the home. Resident aids and equipment have been serviced, this includes hoists and baths and maintenance work is up to date. Fire records are up to date and the lift has been serviced and is currently in good working order. Portable electric appliances are subject to visual examination only and this is insufficient to ensure the safety of people in the home. The last Periodic Fixed Electrical Installation Inspection was made in May 2003 and was recommended to inspected again after one year. This needs to be done in order to ensure the safety of people in the home. The health and safety of people in the home is promoted by a planned programme of statutory training for staff in moving and handling, fire safety, infection control and control of substances hazardous to health (COSHH). Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X 2 X X 3 X 2 STAFFING Standard No Score 27 X 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 x 2 Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15, 17 Requirement The manager must ensure that care plans are written to describe in detail the actions required to meet all the needs of residents in respect of their health and welfare. The manager must ensure that care plans are up to date and reflect the current needs of individual service users. The manager must ensure thet accurate and appropriate records are maintained of the incidence of pressure sores, their treatment and outcome in service users individual care plans. The manager must ensure residents’ weight is monitored, recorded and action taken for residents that have weight loss The manager must ensure that the dignity of residents is upheld at all times. Timescale for action 31/03/06 2 OP7 13, 15 31/03/06 3 OP8 12, 13 31/03/06 4 OP8 12, 13 31/03/06 5 OP10 12 15/03/06 Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 22 6 OP19 13, 23 7 OP19 8 OP26 9 OP28 10 OP33 11 OP36 The Registered person must ensure that all parts of the home are free from hazards to safety and the home is kept in a good state of repair. Issues addressed in this report must be actioned which include the carpeted area in the corridor. 12, 13, 16 The premises must be kept clean, hygienic and free from offensive odours. The issues highlighted under the environment section of this report must be addressed. 13, 16 The registered person must ensure that the walls and flooring in the laundry are washable and none permeable. This is outstanding from the previous inspection and requires urgent attention 18 The manager is to confirm arrangements to ensure at least 50 of care staff achieve an NVQ II in Care as soon as possible. A list of all care staff that are to undertake this training is to be forwarded with dates for training to be completed. 24 The registered person must ensure that there is a suitable quality assurance and quality monitoring systems in place and records are maintained and available for inspection. 18 The registered person must ensure that all care staff receive formal supervision six times a year and records are maintained and available for inspection. This is outstanding from the previous inspection and requires urgent attention 30/04/06 30/04/06 30/04/06 30/04/06 31/05/06 31/03/06 Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 23 12 OP38 13 13 OP38 23 14 OP38OP19 13 The registered person must ensure that all portable electrical equipment is checked prior to use and on a yearly basis. Visual checks are not sufficient. This is outstanding from the previous inspection and requires urgent attention The registered person must ensure that a full Legionella assessment is conducted and an action plan produced to reduce assessed risks. This is outstanding from the previous inspection and requires urgent attention The registered person must ensure that the fixed electrical installation in the home is inspected as recommended in order to reduce unnecessary risks to the health and safety of people in the home. A copy of the report must be forwarded to the commission. 31/03/06 31/05/06 31/05/06 Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 24 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 OP8 Good Practice Recommendations The inspector recommends that the home implement the use of a tool to identify residents at risk of developing pressure sores. Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Red House Residential Home DS0000004285.V282497.R01.S.doc Version 5.1 Page 26 - 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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