Inspection on 19/04/06 for Rivelin House

This inspection was carried out on 19th April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rivelin House 04/04/08

Rivelin House 05/10/07

Rivelin House 10/08/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Rivelin House 498 Bellhouse Road Sheffield South Yorkshire S5 0RG Lead Inspector Stuart Hannay Key Unannounced Inspection 19th April 2006 09:45 19/04/06 Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 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 Rivelin House DS0000063343.V288853.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 Adults 18-65. 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. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rivelin House Address 498 Bellhouse Road Sheffield South Yorkshire S5 0RG 0114 2577911 0114 2577933 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) londonroad@tiscali.co.uk Milbury Care Services Limited Mr Richard Vincent Burton Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Rivelin House is a care home providing personal care including nursing care for eight residents. The home is owned by Milbury Care Services Limited and is situated in the Shiregreen area close to local shops and amenities and on a main bus route. There are eight rooms for single occupancy situated on two floors the upper floor is accessed by a lift. All rooms are for single occupancy, each having an en-suite accessible for wheelchairs and fitted with overhead tracks for hoists. One of the rooms has its own kitchenette, lounge/dining room, bedroom, en-suite and its own fenced garden area. There are garden areas accessible to residents, these areas are private and appropriate garden furniture is provided. The scale of charges ranges from £1700 to £3400 per week. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on two days. On the first day, two of the service users and three staff members were interviewed. It was not possible to formally interview most of the service users due to their level of disability. A range of records was checked, including service users’ care plans, medication records and staff training records. An inspection was made of the premises. A further short visit was made on the following day to interview the manager who was on leave on the first day. Staff recruitment records were checked on the second day. Seven service users completed surveys with the assistance of their carers and the manager completed a pre inspection questionnaire. At the time of the inspection the home had 6 service users with 2 vacancies. What the service does well: What has improved since the last inspection? What they could do better: A review is needed of the staffing levels, which had been reduced in the weeks prior to the inspection, as service users numbers had dropped from 8 to 6. As some service users had specific contracts which state that they would have constant 1:1 care or even 2:1 care, staff felt that this reduced the time available to meet anything other than the basic care needs of service users. The staffing ratios appear high, 4 or 5 carers and 1 qualified nurse for 6 Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 6 service users, however the majority of the service users need 1:1 attention throughout the day. There were qualified nurses on every shift but on some weekend shifts the number of carers was as low as 4– even when none of the service users were on leave. Some new staff members had not received statutory training, including manual handling and fire safety and some staff had not had updated training in these areas. Fire alarms had not been consistently tested and certificates were not available to show that annual testing had taken place on the fire and gas systems. 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. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 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 the following standard(s): 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Full assessments take place to ensure the service is suitable and service users wish to move to the home. EVIDENCE: Three care plans were checked. These contained detailed assessments of the service users’ needs and how the proposed service at Rivelin House would be able to meet these needs. The assessments included full consultation with placing professionals and, where appropriate, service users’ relatives. Assessments were very specific in one of the care plans seen and stated that the contract included “a flat and two staff members to work with [him] at all times”. One service user spoken with confirmed that he had been able to visit the home prior to moving here and that he had been helped to settle in when he arrived. Most of the service users confirmed in their questionnaires that they had received information about the home and had been able to visit prior to moving in. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ plans identify how staff can help them meet their needs and promote their independence. There was evidence of consultation with the service users or their advocates with regard to decision making. Service users are able to take reasonable risks as part of their everyday lives. EVIDENCE: It was difficult to fully assess if service users had been consulted about their care plans. One service user said that although they had been asked on a regular basis about their care, they had not seen their care plan. However, on checking the plan, each section had been signed. It was clear that the staff had drawn on a wide range of sources to try to discover what the service users wanted and how they wished to spend their lives. This was complemented by what the staff had learned about the service users since their admission. Support staff confirmed that the plans are reviewed regularly and their opinions sought – the nursing staff had regularly reviewed the 3 care plans checked. The care plans contained risk assessments for daily activities and Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 10 service users were not overly restricted in what they could do. One care plan checked indicated that the service user’s relative, with the service user’s consent, had been involved in decisions about their care and treatment. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users regularly use local facilities with staff support, which they seem to enjoy along with a range of social trips. The provision of leisure and social activities is valued at the home but staff felt that the reduction in staffing levels will affect this. EVIDENCE: Service users care plans contained information about how they could be involved in the community. These included using local facilities such as shops, pubs and the local leisure centre. Activities included trips out to the zoo, bowling, the cinema and ice-skating. The GP surgery is also close at hand. One service user spoken with was involved in further education and was supported in this. Staff were concerned that recent reductions in staffing hours were going to have an effect on their ability to do outside trips with people, as these require high staff ratios. They felt that with 5 carers on duty and 2 of the 6 people assessed as needing 1:1 care and one assessed as needing 2:1 care, Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 12 this would mean that 1 carer was then responsible for 3 service users. The opportunities to go out would thus be limited. They felt that it would be useful if more people were able to drive the minibus. Staff said that one of the qualified nurses was now the activities co-ordinator – they felt this was a very positive move but one that would be countered by reducing care staff hours. Care plans seen addressed service users’ needs to express their sexuality and appropriate ways to support them in this. One service user spoken with felt that he had a reasonable amount of control over how he spent his time at the home and could choose when to get up, when to go to bed and what activities to be involved in, including educational and leisure activities. He acknowledged the need for a set routine at times, even if he didn’t always want to get up. Generally, routines appeared to be flexible and some service users were having a lie in on the day of the inspection. Two service users were observed having breakfast; assistance was given where necessary but service users were encouraged to do as much as they could for themselves. The midday meal was not observed but one service user said he thought that the food, prepared by the support staff, was good and hoped to be able to be more involved in the preparation of his meals in the future. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ personal care needs are recorded in detail in the care plans. There are detailed health records in the care plans. The medication system is generally well managed but handwritten entries must be signed and checked to ensure they are accurate. EVIDENCE: One service user said that the staff met his personal and healthcare needs. This was reflected in his care plan and in the care plans of 2 other service users who were not able to clearly say whether their needs were met. Healthcare records were detailed and there was evidence of good liaison with other healthcare professionals, including GPs, district nurses and hospital based staff. Prescribed treatments had been incorporated into the care plans where necessary. No service users currently manage their own medication. The medication was stored appropriately in the home, in a locked cupboard within a lockable storeroom. All labels were intact on bottles and boxes and these could be clearly read. All medications seen were for named individuals currently at the Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 14 home. The MAR (medication administration record) sheets were fully completed and variable dosages for warfarin and insulin were recorded. Handwritten entries for medications prescribed in-between monthly deliveries appeared to accurately reflect prescription information but had not been signed by the person making the entry, or countersigned by a witness, to show they had been checked and confirmed as accurate. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to make complaints and there is a system in place to record and report complaints, which service users and their advocates can use to raise concerns. There are systems in place to ensure adult protection allegations are reported and acted upon. EVIDENCE: One service user said in interview that he could, and did, make complaints about the service. He was aware that there was a formal complaints system but did not feel it had been necessary to use it so far. Four of the service users said in their questionnaires that they were aware of the complaints system – two people were unable to say. There is a complaints book, the nurse in charge said that there were no current complaints. There was one complaint on file, which had been raised by a neighbour and this appears to have been resolved. Staff felt that service users who were unable to verbally express their views were able to make their feelings known. Some staff had received training in adult protection and there had been an allegation at the home since the previous inspection. This was appropriately referred to the adult protection team via the home’s procedures and fully investigated. The CSCI were involved in this process throughout and extra staff support and supervision has been provided since. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 24, 25, 26, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and tidy enabling service users to live in a pleasant environment. Specialist equipment was in place in the bathrooms and bedrooms to enable service users to be more independent or ensure that provide full assistance. EVIDENCE: Bedrooms were pleasantly decorated and service users were able to personalise them as they wished. Specialist equipment, such as fitted hoists with ceiling tracking were provided in bedrooms where this was needed. Three bedrooms were checked and had en suite shower facilities, suitable for people with a physical disability who may have to use a wheelchair. Bathrooms were similarly equipped: there was one on each floor and a shower room, which was not currently in use. There is a passenger lift, one of the service users who has a wheelchair showed the inspector how to use it, all the controls were at a suitable height. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 17 There were no unpleasant odours in the home on the days in which the inspector visited. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff work in a supportive environment and full checks are completed prior to them starting work, ensuring the safety of the service users. There were qualified nurses on each shift however the number of care staff deployed has been reduced recently which staff felt was affecting their ability to provide much more than basic care. Staff training is in place but some staff have not had updated statutory training such as fire or manual handling potentially placing themselves and service users at risk. EVIDENCE: There are qualified nurses on duty for each shift over a 24-hour period. Care staff interviewed felt that the nurses were supportive, helpful and responded well to any concerns or suggestions they might have about service users’ care. They felt that the nurses and the manager valued their opinions. The records were checked of 2 staff members recently recruited to work at the home. Both had completed application forms, had 2 written references and CRB and POVA checks. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 19 Three of the care staff interviewed had completed or were undertaking NVQ Level II. There was a comprehensive training programme for the forthcoming year provided by the organisation, however a number of staff interviewed had not had recent statutory training involving fire safety or manual handling. One person interviewed said she had not had any formal fire training since starting three months ago. In spite of this, all the staff interviewed were aware of the procedures to be followed in the event of a fire, including evacuation to a safe zone for wheelchair users on the first floor. The fire drill records showed that regular drills are carried out and the staff response has been good. Two staff members said that they had not had manual handling training since starting at the home; one said that he had performed manual handling tasks, although always under supervision. The home’s training procedures state that the manual handling training certificate is valid for 12 months -three other staff members interviewed said that they last had manual handling training on their initial induction but this was over 14 months ago. The manager has a nursing qualification but has not yet achieved NVQ Level IV in Management. There is a system of formal staff supervision but staff members interviewed said that they had not received this at regular frequencies unless there was a particular issue. As noted above, in line with a recent reduction in the numbers of service users, staffing hours had been reduced. There was no evidence at present that this was having an impact on the health and welfare of the service users; however, as a number of the service users are on contracts which guarantee that a staff member will be with them at all times, this must be reviewed both with the company’s managers and the agencies paying for the services. One service user requires two staff to be working with him whenever he is awake. Three staff members interviewed stated that they had worked on their own with him on more than one occasion. Whilst there is no evidence that this placed the service user or the staff member at risk, this practice must be reviewed. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 20 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 and 43. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was a friendly atmosphere at the home and staff demonstrated a positive attitude towards the service users. Fire safety records, including alarm testing and staff training were poor, potentially placing staff and service users at risk. EVIDENCE: The home’s manager is an experienced nurse and demonstrated a good knowledge of the service users’ needs. Throughout the inspection, the impression was that the staff were committed to supporting and enabling the service users to lead fulfilling lives. The home’s line manager has carried out regular unannounced visits to the home and interviewed staff and service users. She has conducted inspections of a variety of records, checked the environment and provided a written report. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 21 Fire alarm testing records had not been completed on a regular basis. The fire safety system had not had an annual check and the home’s gas safety certificate was out of date. The manager said that he had not been able to obtain a copy of the gas certificate from the company that manages their building maintenance. Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 22 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 Standard No Score 1 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 1 3 Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 23 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. Standard YA14 Regulation 12 (b) 18 (a) Requirement The home must ensure that sufficient staff are available to ensure that service users can partake in activities, in and out of the home, on a regular basis. All handwritten instructions for medication on the MAR sheets must be signed by the person making the entry. A second person must sign to confirm the information is accurate according to the printed label. The home must review the recent reduction in care staff hours and must take into account the details of the contracts which guarantee that staff will be allocated to specific service users throughout the day. All staff who have not attended external fire training in the previous 12 months must have in-house training. Records of fire training must be kept updated. All staff who have not attended moving and handling training in the previous 12 months must have in-house training. Records of manual handling training must DS0000063343.V288853.R01.S.doc Timescale for action 01/07/06 2. YA20 13 (2) 01/06/06 3 YA33 18 (a) 01/07/06 4 YA35 23 (4) (d) 01/06/06 5 YA35 13 (5) 01/06/06 Rivelin House Version 5.1 Page 24 be kept updated. 6 7 8 9 10 YA35 YA36 YA42 YA42 YA42 The minimum of 50 of care staff should have NVQ qualification by December 2006 18 (2) Staff should receive formal supervision sessions on a regular basis. 23 (4) (iv) Fire alarms must be tested on a weekly basis. 23 (4) (iv) The fire alarm system must be serviced on an annual basis and a certificate obtained. 23 (2) (c) The home must obtain a certificate to show that the gas central heating system has been serviced. 9, 18 The manager must start the NVQ level 4 course (or equivalent) in management. 18 (c) (i) 24/12/06 01/06/06 01/06/06 01/07/06 01/07/06 11 YA38 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rivelin House DS0000063343.V288853.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Rivelin House DS0000063343.V288853.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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