Inspection on 02/08/05 for Repton Road,73

This inspection was carried out on 2nd August 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

Repton Road,73 13/12/06

Repton Road,73 30/12/05

Repton Road,73 22/03/05

Repton Road,73 16/07/04

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

Hartley House

Brook Drive, 124

Rugby House Project

City Roads Crisis Intervention

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

CARE HOME ADULTS 18-65 Repton Road 73 Repton Road Orpington Kent BR6 9HT Lead Inspector Wendy Owen Announced 2 August 2005 00:00 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Repton Road Address 73 Repton Road Orpington Kent BR6 9HT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01689 86661 01689 86661 Community Options Ltd Emy Nervaza CRH 5 Category(ies) of D5 registration, with number A 5 of places MD 5 Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 5 Adults with Mental Disorder who may also have or present alcohol or drug dependancy Date of last inspection 21/01/05 Brief Description of the Service: 73 Repton Road is a large two-storey semi-detached house in a quiet residential area, providing care and accommodation for five adults with mental ill health. This home is part of a group of homes within the community that specialises in residential care for people within the mental ill health category. The home is staffed by a manager and team of support workers providing twenty-four hour care. Service users’ accommodation is on both floors, accessed by steep stairs, making it unsuitable for people with significant mobility difficulties. All bathroom, toilet and bedrooms are fitted with locks that can be accessed from the outside in case of an emergency. Service users have appropriate medical cover on admission and each service user is registered with a GP of their choice whenever possible. They also receive treatment from a range of other health care professionals as required. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day and included discussions with staff; viewing of records; a tour of the home and written feedback from residents, relatives and care managers. This written feedback showed that no residents wished to speak to the inspector during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Whilst staff demonstrated an ability to provide support to residents in improving their mental health, there is a need to improve on the care plans, in relation to the overall needs of residents. This must also include ensuring residents’ nutritional needs are addressed and adequate records maintained. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 6 Medication procedures also require some improvement to ensure they are completely safe and not reliant on passing of information by word of mouth. This is also true of the fire procedures, where a lack of fire signs and notices, providing direction during a fire, are absent. The environment was of a satisfactory standard of cleanliness, although more in depth cleaning is required to ensure standards are maintained. The quality of the “smoking room” carpet and kitchen walls does little to improve, an otherwise, well-maintained, well -decorated and homely communal areas. Feedback indicates that residents wish to be more involved in decision-making within the home and therefore the home should investigate how this could be improved upon. Recruitment procedures do not currently meet the regulations with the home needing to ensure all the required information is maintained within the home and robust checks are made throughout the recruitment process. 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. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 & 4 The home’s admission procedures ensure that the home obtains information, regarding the resident’s care needs, from agencies and individuals involved in meeting their care needs. The process provides for residents to visit the home prior to any decisions being made to ensure the home is the most suitable place for the individual. EVIDENCE: The home has all of its “places” referred through the local authority. The organisations admission’s procedure requires the home to obtain a referral followed by the care co-ordinator’s assessment of need and information from any other agency involved, including health professionals. A senior member of the organisation is responsible for meeting and assessing each prospective resident using the above information. An integral part of the process requires the resident to visit the home, view the accommodation and meet the residents and staff. These visits are flexible and are determined by the individual needs. They may be one or more visits and may include overnight stays. Written feedback from residents, families and residents One Care Manager said that the standard pf care is “Generally good” followed by “The home has a philosophy of doing with not doing for people. Another Care Manager stated believed the standard of care is “Very good.” All five of the residents’ feedback cards stated that they liked living in the home and felt well cared for. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 9 The home has good working links with the specialist services, including consultant psychiatrist and the social services care management community mental health team. The Community Psychiatric Nurse (CPN) visits the home on a regular basis to monitor service users and medication Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7, 8,9 & 10 Care plans and risk assessments are not fully reflective of the whole needs of the residents, which means needs may not be fully met and residents are potentially at risk. Whilst the home promotes residents’ involvement and participation in decision-making about their lives and how the home should be managed, such involvement could be improved upon to ensure all residents are empowered. EVIDENCE: Two care plans were viewed and found to contain information regarding the personal goals and aspirations of each resident. There was also some information regarding the identified needs of the individual but this information was not evident throughout and therefore the care plans do not reflect fully reflect the emotional, mental and physical needs of the individuals. There is evidence that the organisation is currently reviewing the care planning records with a view to meeting the regulations. (See requirement 1) The care plans are supported by individual risk assessments detailing areas of identified risk and any action the home is taking to minimise the risks in order for the residents to maintain their independence. The home also records any restrictions or limitations placed on the individual. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 11 One care manager stated that the home has a philosophy of “doing with and not doing for individuals” and that the residents are treated as equals and included in the decision-making process. Whilst another Care Manager stated that “They (staff) listen to views of service users. Try and give them choices and live as independently as possible (within limits of their illness).” The written feedback from the residents showed that two of the five completed questionnaires identified that they wished to be more involved in the decisionmaking within the home and a further two said that they wished this, sometimes. There is evidence of residents’ meetings and discussions and residents are able to make decisions on whether they wish to manage their finances. However, the home should try and investigate with individuals, how involvement could be improved upon. (See recommendation1) Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15,16,17 The home provides opportunities for many of its residents to lead a fulfilling life. This could be improved upon for others. More clarity and involvement is required from the home in ensuring residents are receiving a healthy and nutritious diet to ensure their physical and mental well-being. EVIDENCE: Feedback from relatives, Care Managers and residents presented mixed views on the activities undertaken by residents. One care manager said that this area “is not a strong point” and that the home relies on them to initiate involvement, rather than initiate social inclusion for residents, whilst another said that the home encourages residents to attend adult education, day centres etc. Further feedback also states that the home could be more proactive in encouraging their family member to participate in activities. This is a difficult balance for the home. Residents’ mental health condition and rights often restrict the home’s ability to make a difference. The inspector suggests that the home investigates how this area could be improved upon Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 13 with residents, care managers and family involvement (where agreed). (See recommendation 3). Feedback also showed that relatives and care manager at times have concerns, that their family members are not receiving a healthy diet. Residents are responsible for the purchasing, preparation and cooking of their meals with staff support. However, there is no monitoring or record of meals taken. This is once again a difficult balance with residents’ rights and independence being promoted. However, the home must understand that there are times when residents’ ability to make decisions is impaired by poor health or lack of insight into the need to have a nutritious diet. (See requirement 3) Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The medication procedures require a little improvement to ensure safety of residents. The home promotes the health and well-being of residents through NHS & specialist support. EVIDENCE: All residents are registered with a local GP and also receive support from community mental health services. The feedback generally shows that the home accesses health care services and staff attend appointments with residents, when necessary. The home has very good links with specialist services, where the resident may need immediate intervention and CPNs attend to monitoring of medication and mental health needs. There is also evidence of accessing national health services, such as dentists, chiropodists and optical care. However, one feedback indicates the home could improve the communication regarding their relative’s physical health care needs. Medication procedures were satisfactory. However, there were some areas of improvement identified, such as the need to label individual daily trays to prevent any mix ups; ensure the labelling of medication corresponds to the medication record and to develop guidelines for the administration of “as required” medication. These guidelines were developed prior the completion of the inspection. (See requirement 2) Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 15 Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 &23 Complaints are handled satisfactorily and residents feel any concerns voiced will be listened to and acted upon. Vulnerable adults procedures are in place with staff showing an understanding of how allegations should be managed to ensure residents are protected. EVIDENCE: Residents stated they knew who to talk to if they want to discuss their care needs or any concerns and the complaints procedure on display in the hallway provides information on how the home manages complaints. There have been two complaints in the last twelve months, which have been investigated and substantiated by the manager. Leaflets are available to service users and displayed on their notice board informing them on how to make a complaint along with information on the “Bromley Advocacy Service”. Staff have attended ‘Adult Protection’ training through social services. The home has a procedure regarding the action staff are required to take where allegations are made or there is evidence of abuse or neglect which is supported by a “whistle-blowing” policy. There is also a policy on bullying and action for supporting staff members. Service users sign an agreement if they wish their money to be held in safekeeping and all monies held are audited twice a day at handover periods and signed by two staff members. Currently only one resident has personal monies held by the home. This was audited by during the inspection and found to be in order. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27,28,29,30 The home provides a safe, comfortable and homely environment for residents, with the exception of a few areas requiring improvement. EVIDENCE: The communal accommodation consists of a smoking lounge/dining area, kitchen and a non-smoking sitting room. They are decorated in a homely way and domestically furnished with comfortable furniture. The carpet in the smoking room will require replacing in the near future and should be included in any action plan for environmental improvement. (See recommendation 2). The kitchen is furnished to a good standard with contemporary units. Residents’ food purchases are kept secure in individual lockable units. However, one of the walls is rather marked and requires repainting or redecorating. (See requirement 4) The bathrooms and toilets are of a basic standard of decoration with no personal touches and therefore could be made more homely. They are however, fitted with appropriate locks to enable access in case of an emergency. The home is generally clean and tidy with residents having to complete weekly chores around the home. However, there is evidence of the need for more intensive deep cleaning, to ensure the build of dust and dirt is restricted. The Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 18 laundry facilities are separate to the kitchen area therefore minimising any risks of cross infection in this area. (See requirement5) Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35, 36 It is difficult to determine the actual number of hours and deployment of staff within the home. Clarity is required to records to ensure the home is staffed to meet residents’ needs and to ensure their safety. Staff are well trained and have an understanding of residents’ needs, although there is a delay in some aspects of training for new staff. Recruitment procedures must be more robust to ensure to offer residents protection. EVIDENCE: The manager, deputy manager and support staff support residents to live their lives and to meet their goals. There are no ancillary staff employed. The staffing level within the home is difficult to ascertain due to the staff also providing hours to a supported living environment. The staff roster must be amended to indicate the actual hours provided to the home, separating the hours provided to the supported living environment. (See requirement 6) Comments from the care management team include “I believe staff all act professionally and I see them as competent and capable”. Training provided is appropriate to the individual needs of resident and new staff undertake induction training within the home. However, there are times when the organisations’ induction/foundation training is delayed, which means the new member of staff is not provided with the appropriate training, including core training, during their first few months. (See requirement 7) Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 20 It is positive to note that all staff, with the exception of the newest member of staff, are trained to NVQ 2 standard and the majority of written feedback indicates that staff have an understanding of the residents’ needs. Staff spoken to felt that the home and organisation offers, not only training, but support in developing skills and knowledge to provide them with an opportunity for development within the organisation. Staff also stated how proactive and supportive the manager is in developing individual members of staff. Discussions with staff showed that they are provided with regular formal and informal supervision. The recruitment procedures require some improvement in line with the amendments to the Care Homes Regulations in 2004. Written references; exploration of gaps in application forms; verification of previous employment in care and the requirement to ensure copies of birth certificates are held in the home, are required. (See requirement 8) Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Overall the home provides and maintains a safe environment for residents and staff. However, there are some areas which require a little improvement to minimise potential risks. EVIDENCE: The home maintains well -organised records in relation to the health and safety of the residents and staff. A sample of these were viewed and found to be in date and appropriate. A tour around the home identified a need for the home to place fire notices in appropriate places to ensure all individuals can follow these directions in the event of a fire. Staff undertake First Aid; moving and handling and food hygiene training and where some of the training may be due to expire these have been identified in the individual’s training needs. However, whilst staff have undertaken moving and handling training some of the training took place in 2003. The inspector recommends that the moving and handling requirements of residents are risk assessed in order to determine whether annual updates are required. (See recommendation 4) Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 22 Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 2 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 2 3 x 2 Standard No 11 12 13 14 15 16 17 x 2 3 2 3 3 2 Standard No 31 32 33 34 35 36 Score x 3 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Repton Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 24 no Are there any outstanding requirements from the last inspection? 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 6 Regulation 15 Requirement The Registered Person must ensure care plans reflect the mental, emotional, physical and spiritual needs of the individual. The Registered Person must ensure that medication procedures promote the safety of residents. Specifically, all prescribed medication must be labeled with the individuals name; the administration on the pharmacy label must corrspond to the administration recorded on the medication record. The Registered Person must maintain a record of the nutritional intake of residents and promote their nutrional wellbeing. This must include a record of actions taken by the home to meet these needs. The Registered Person must repaint or re-decorate the kitchen walls. The Registered Person must ensure the home is kept clean. Specifically, arrangements must be made for regular deep cleaning. The Registered Person must G51G01s6908Reptonv233285.2.8.2005stage4.doc Timescale for action 01/10/05 2. 20 13 01/09/05 3. 15 16 01/10/05 4. 5. 28 5 23 01/11/05 01/11/05 6. 33 18 01/10/05 Page 25 Repton Road Version 1.30 7. 35 18 8. 34 17 , 18 & 19 23 9. 38 ensure that the staff roster provdes clear information regarding the staffing within the home. There must also be clear records of the number of hours spent by staff, providing support to the supported living environment. The Registered Person must ensure all new staff are provided with core training wothout delay in order that staff and residents health and safety is promoted. The Registered Person must ensure recruitment procedures are robust enough to protect residents withint he home. The Registered Person must ensure fire notices are placed in appropriate areas of the home to ensure residents and staff can follow these directions in the event of fire. 01/10/05 01/10/05 01/09/05 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. 4. 5. Refer to Standard 7 28 12 & 14 13 Good Practice Recommendations The Registered Person should investigate how the home can improve the residents involvement in the decisionmaking within the home. The Registered Person should supply the Commission with details for the replacement of the smoking room carpet. The Registered Person should actively promote and encourage residents involvements in activities and leisure interests. The Registered Person should risk assess the mvoing and handling requirements of residents within the home in order to determine the appropriate action. Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 Page 26 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent DA14 5RH 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 Repton Road G51G01s6908Reptonv233285.2.8.2005stage4.doc Version 1.30 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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