Inspection on 05/02/08 for Rowden House

This inspection was carried out on 5th February 2008.

CSCI found this care home to be providing an Adequate service.

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

Rowden House 12/02/09

Rowden House 18/12/06

Rowden House 04/01/06

Rowden House 18/08/05

Rowden House 29/03/05

Rowden House 28/10/04

Rowden House 16/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Rowden House 2 Vallis Road Frome Somerset BA11 3EA Lead Inspector John Hurley Key Unannounced Inspection 09:30 5th February 2008 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 Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rowden House Address 2 Vallis Road Frome Somerset BA11 3EA 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) 01373 462271 01373 454494 Somerset Care Limited Mrs Rebecca Jane Culblaith Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Rowden House is situated in Frome, close to local shops and facilities. The house is a Grade II listed building that has been extended to provide further accommodation. There are three day rooms at the home; one of which has been designated as a smoking room. There are also furnished patio areas at the front and rear of the home, which are used by service users and their visitors. Rowden House is registered with the Commission for Social Care Inspection to provide care for up to 39 service users over the age of 65 years who require assistance with personal care. The fees for residency at Rowden House range from £373 to £450. The Registered Manager is Mrs Rebecca Culblaith. The home is owned by Somerset Care Ltd. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. This was the first unannounced key inspection of Rowden House care home for the inspection year 2007/8. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. This included paper surveys of residents and people important to them. The manager of the home completed an Annual Quality Assessment Audit (AQAA) document prior to the inspection. Comments from all who use the service were positive, indicating they were very satisfied with the quality of the service they receive. A tour of the premises was made, interaction between staff and people who use the service observed, as well as care practices that included the administration of medicines and the serving of food. The inspector toured the building, spoke with staff on duty, five people who use the service, one visiting professional and two relatives during the course of the inspection. They all provided a very positive account of the home. The inspector sampled some of the residents documentation along with records relating to staff and other records required by regulation. What the service does well: The home continues to offer a warm welcome and a pleasant relaxed atmosphere throughout. People who use the service appeared to be relaxed in a safe environment with full staff support. Residents were generally observed being treated with respect and care that appeared to be offered in a way that protects their right to privacy and dignity. Staff interact with residents in a friendly and caring manner. It was clear from observation and the time spent with residents that they felt comfortable and very at ease with staff. Staff seen confirmed that an induction process is undertaken. The staff are appropriately supervised and training continues to be valued by the staff. Service users access to health and social care services are well documented. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The registered manager must ensure that; • • The statement of purpose is updated to ensure that accurate information is given to all prospective residents. Initial assessments of need must be recorded and a statement is made that the home can meet the assessed need in order to ensure they are met. The care plans and associated reviews must contain sufficient details to inform staff of how to met resident’s needs in a safe and agreed manner. The administration of medication must be improved to ensure the protection of residents. • • 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. The summary of this inspection report can be made available in other formats on request. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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 Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose requires updating to ensure that accurate information is given to all prospective residents and people important to them. Recorded initial assessments of need must be made on all prospective residents to ensure that needs are ascertained and an agreed plan of care as to how these will be met. EVIDENCE: The inspector looked at the home’s statement of purpose and established that this document now requires updating to reflect the current arrangements at the home. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 9 The feedback given via questionnaires confirmed that prospective residents had been consulted about their individual needs and how they would like them to be met. The inspector looked at the initial assessments of need for the last three people to take up residence. Two of these assessments contained basic information, which would be greatly improved by recording more detail about how needs, are going to be met. In one case the person was already known to the home through the day services on offer in an adjoining building. This person did not have an initial assessment. All new residents are required to have an initial assessment to ensure that their needs are identified and a plan to meet them developed. The home offers short term care which they call “step down, step up” services. The inspector looked at the documentation available for the next person who was shortly to take up short-term residency. The documentation contained a care management assessment made by a social worker and an assessment made by the home. Through discussion with the registered manager the inspector established that the registered manager had discussed what was going to happen with this short-term placement with the individual. However, no formal recorded plan was in place that demonstrated the aims and objectives of the stay. There was no recorded plan with regards to any therapeutic input from outside the home although it was agreed there would be some. These issues need to be formally addressed in the case of a planned admission. The home does not consider these services to be intermediate care as they do not offer any specialised or rehabilitation services to meet the requirements of intermediate care. The management of the home should take a more proactive stance with regards to the mental capacity of residents, especially when carrying out initial assessments. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans and associated reviews need to accurately reflect the changing circumstances of the individual in order to provide direction to staff with regards to the needs of the resident. The recording of medication administered must improve to ensure the protection of those who use the service. EVIDENCE: All of the care plans examined are based upon information provided from preadmission assessments. Following admission to the home, further assessments are carried out and the home draws up a care plan identifying the needs of each individual and how staff are to meet these needs. The plans that were sampled would benefit from more detail to instruct staff with regards to the care required. In one case the documentation failed to Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 11 acknowledge a disability that affects the individuals behaviour in certain circumstances. The reviewing process was also looked at and also found to lack detail, for example one person who had recently returned from hospital care plan had been reviewed and now stated that the resident’s food was to be pureed. There was no indication to suggest where this instruction had come from or any associated risk assessment to look at the issue in depth. There was no recording to suggest the person had been consulted about this and their daily record suggested that this instruction had not always been carried out. The inspector discussed these issues with the manager and explained where improvements are required to meet the National Minimum Standards. However as there are more strengths than weakness’ in the care planning process and a commitment from management to get it right, further time will be allowed for these commitments to be acted upon. Feedback from visiting professionals given via questionnaires and discussion at the time of the inspection informed the inspector of good professional relationships. They further confirmed that the people who use the service attend appointments and have their health care needs met. Interaction between staff and residents were observed as friendly and respectful. Through discussion with the individuals the inspector was informed that the care staff fully respected their privacy and dignity. Residents informed the inspector that they are not made to do anything they did not wish to, such as attending activities or having meals in the dining room. Staff were observed knocking on doors before entering. People who use the service are able to meet privately with visitors in their bedroom or in one of the lounges. They further confirmed that all personal care was provided in the privacy of their bedrooms or bathrooms. The care plans and associated documents supported these representations. Medicines are stored well. There was a fridge for medicines needing refrigeration and the temperature was being monitored and recorded. Whilst there have been improvements in the medication and administration systems since the last inspection the accepted standard has yet to be reached consistently. The inspector showed the registered manager a sample of administration records demonstrating where their concerns were, for example, there were significant gaps in the recording of one individuals medication, one resident who was self medicating had not signed to state that they had received their medication, one persons medication had run out for a day and some medication that is prescribed on a per required needs basis is given regularly suggesting that a medication review should take place. The registered manager acknowledged these comments at the time of the inspection. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pace of life appears to suit the resident’s expectations and aspirations. Visitors are welcomed and individuals are assisted with maintaining contact with relatives and friends. The food is home cooked and appears to offer a balanced diet. EVIDENCE: People who use the service were observed in a number of different locations. They choose when to get up and when to retire. They can have a key to their bedroom and to keep it locked if they wish. Residents are able to meet privately with visitors either in their rooms or in a designated lounge. Those who were spoken with indicated that they were happy with their life in the home and confirmed having freedom of movement and that staff support them in following their preferred lifestyle. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 13 The inspector discussed with a number of the residents how they spend their day and what activities were available. It was established that most afternoons there are activities, some are enjoyed more than others, but in the main everyone considered there was enough to do. Those who can, access the wider community on their own. Visitors were observed entering or leaving the home. All visitors were warmly welcomed. The inspector spoke with one relative who spoke highly of the home. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies relating to complaints and the protection of vulnerable adults. EVIDENCE: A complaints procedure is in place. The people who the inspector spoke with informed them that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the manager is very approachable and will deal with any issues, no matter how minor, there and then if they could. The home keeps a record of any complaints made. There have been no issues recorded at the home, similarly there have been no complaints made directly to the regulator. The complaints procedure was displayed and issued to new service users. The Protection of Vulnerable Adults (POVA) training manual was available, staff confirmed having training regarding the POVA, and the manager confirmed that a POVA check is performed at the time of requesting a CRB check prior to starting work. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from comfortable, safe and well maintained surroundings. Residents can personalise their private space and contribute to the décor of communal areas. Residents benefit from a home that is generally maintained in a clean and tidy condition. EVIDENCE: The inspector toured the premises unaccompanied when they first entered the home inspecting a number of communal areas. They found that the home was generally clean in all areas observed. It was noted that all toilet and bathrooms were found to be clean and hygienic. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 16 At the last inspection the inspector was informed that there were vacancies for cleaning staff. These vacancies have now been filled and the effects have resulted in a higher standard of cleanliness throughout the home. The resident’s accommodation is provided over three floors. There is a passenger lift, assisted bathroom and call system available to residents; people commented that call bells are answered promptly. There are two large communal lounges and one dining room. Activities can be held in these large communal areas. These areas are domestic in nature providing comfortable seating and dining facilities. There is evidence of new seating being provided in the communal areas and the registered manager informed the inspector that more are on order. The corridors are well illuminated with a number of prints on the walls. There are a number of seats discreetly placed in recesses of the corridors allowing individuals to rest if needed, handrails are also provided to aid independence around the home. There are also areas where people can sit and talk in small groups. One such area has a balcony accessed through patio type doors. Residents are able to bring personal possessions with them into the home. The rooms the inspector observed had been personalised to reflect the individuals taste. One person who had recently took up residency expressed satisfaction with their room and informed the inspector of the efforts that had been made by staff to ensure that they were comfortable and had opportunities to have their own furniture brought in. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28.29.30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff have received regular training with regards to the tasks they daily perform. There is evidence that new staff receive a structured recorded induction into the care home so as to meet the needs of those who use the service. EVIDENCE: The home continues to be well staffed. On the day of the inspection the staff were observed meeting the needs of the residents in a professional and respectful manner. The inspector talked with the staff on duty who were knowledgeable with regards to how to meet the assessed needs of the resident group. The residents themselves confirmed that the staff meet their individual needs in a way that suits them. They further commented that if they use the call system a member of staff will attend to them without too much delay. The staff turnover continues to be low and staff provide good continuity of care. The manager has promoted an ethos that values training and staff were Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 18 able to confirm receiving training to practice safely and for personal development. All staff spoken with had National vocational qualifications. The staff files that were sampled contained sufficient detail with which to establish the prospective employees suitability for the job, all requirements as set out in the National Minimum Standards are fully complied. The inspector spoke with staff that confirmed that they had received an induction into the care home where the needs of the resident group were explained. Statutory training is well documented. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team at the service provide good and positive leadership. The staff group are formally supervised and their work appraised. The health and safety of the all who work and reside at the home is dealt with well. More needs to be done to ensure that the medication practices are safely managed and are brought up to the National Minimum Standards in order to protect residents. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 20 EVIDENCE: The comment cards that have been received from relatives and comments made by the residents and staff, indicate that the home is being managed in a way that benefits the residents. People continue to enjoy a comfortable and pleasant home, which is receiving improvement and investment, as it is required. New staff continue to express appreciation for the assistance given during the induction process and supervision. Notes of frequent supervision were evident in the staff files that were sampled. As in the previous inspection, all records inspected were well organised, well maintained and with the exception of care records up to date. Records inspected included care records, the complaints log, accidents, medication, staff files, rotas, fire logbook, training records, safety checks and maintenance. A tour of the premises found a safe and comfortable home free from obvious hazards. Fire safety equipment has been serviced and tested as required. Staff have been provided with regular fire safety training. Equipment servicing records have been appropriately maintained. All supervisory staff have received First Aid appointed persons training and there is always a supervisor on duty. The home operates a comprehensive system of quality audits to ensure that residents are provided with a safe and comfortable environment. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 13(2) Timescale for action The registered person shall make 25/03/08 suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered manager must ensure that all medication administered is recorded in line with the homes policies and procedures. The previous requirement stated that the registered manager must ensure that any medication administered is recorded on the appropriate MAR sheets by 25/05/07 were not met. 2. OP7 15 (1)(2)(a)( b)(c)(d)13 (4)(c) Unless it is impracticable to carry 04/04/08 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users care plan) as to how the needs in respect of his health and welfare are to be met. DS0000016013.V354800.R01.S.doc Version 5.2 Page 23 Requirement Rowden House The registered person shall make the service users plan available to the service user; Keep the service user plan under review; Where appropriate and unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users care plan and notify the service user of any such revision. The registered person shall ensure that unnecessary risks to health or safety of the service user are identified and so far as possible eliminated. This is with specific reference to 1. Carrying out full and comprehensive risk assessments following significant incidents ie falls or new care regimes, which are robustly evaluated and guide and inform the monthly reviewing process carried out by the home. The previous date to meet this requirement was 4/05/07. At this inspection the requirement was only partially met. 3 OP1 4(1) (a-c) Schedule 1 14(1) The registered manager must update the statement of purpose to ensure that accurate information is given to all prospective residents. The registered manager must ensure that all new residents have an initial assessment of need in order to ensure needs are met. 04/04/08 4 OP2 01/03/08 Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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 OP10 Good Practice Recommendations The registered manager should consider evaluating all care practices to ensure that actions taken by staff do not undermine the dignity of the resident. Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Rowden House DS0000016013.V354800.R01.S.doc Version 5.2 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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