Inspection on 10/04/07 for Shakti Nursing Home

This inspection was carried out on 10th April 2007.

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

Other inspections for this house

Shakti Nursing Home 10/04/08

Shakti Nursing Home 27/01/06

Shakti Nursing Home 05/07/05

Shakti Nursing Home 09/03/05

Shakti Nursing Home 13/07/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Shakti Nursing Home 11 Forty Lane Wembley Middx HA9 9EA Lead Inspector Andreas Schwarz Key Unannounced Inspection 08:00 10th April 2007 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 DS0000022942.V333333.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. DS0000022942.V333333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shakti Nursing Home Address 11 Forty Lane Wembley Middx HA9 9EA 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) 020 8904 7220 020 8903 1934 shaktihome@aol.com Mrs Urvashi Chudasama Evelyn Umamaheswaran Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability (0) of places DS0000022942.V333333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Asian Adults in need of Nursing care, aged 50 years old and above. Minimum staffing notice applies. Date of last inspection 27th January 2006 Brief Description of the Service: Shakti Nursing Home is a registered care home providing accommodation, personal care and nursing care for up to 16 Asian elders; on the day of the inspection there were 16 service users in the home. Mrs Urvashi Chudasama owns the home and the manager is Mrs Evelyn Umamaheswaran.The home is situated on a main road in Wembley Park, within easy reach of local facilities. There is parking for four cars on the forecourt. The home is a large converted three-storey house and was first registered under the Registered Home Act 1984 in August 1997. Accommodation for the service users is provided on the ground floor and first floor, accessed by a through floor passenger lift; there is one shared and 14 single occupancy rooms. On the second floor there is an office for the registered provider and a staff room. There is a garden and patio at the rear of the property. The building is Grade 2 listed. The home is vegetarian for people who are of Hindu faith, but also provides care for people from different religions. Vacant beds can be used for respite care. Fees and charges can be obtained from the registered manager or responsible person. DS0000022942.V333333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection lasted one day during a day in April. The inspector spoke to four people using the service, two visitors, and three members of staff, the manager and the registered provider. The home has returned 13 service users surveys, six has been filled out by the people using the service or their families and seven has been filled out by the people using the service with the help of staff. The home has returned a pre-inspection questionnaire. The inspector case tracked three people using the service and viewed a number of records during this inspection. The inspector would like to thank everybody involved in this inspection. What the service does well: What has improved since the last inspection? The home has met all, but one requirement made during the last inspection. DS0000022942.V333333.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000022942.V333333.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 DS0000022942.V333333.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New referrals are assessed appropriately to meet people using the service needs. EVIDENCE: The home did not receive any new referrals since the last inspection and needs assessments has been assessed as met previously. The home is not providing intermediate care and National Minimum Standards 6 has therefore not been assessed during this inspection. DS0000022942.V333333.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each individual has a care plan but practice of involving people who use the service in the development and review of the plan is variable. There is evidence in the Care Plan of health care treatment and intervention, and a record of general health care information, there are some gaps in information. People who use services are given the support they need to manage their medication. EVIDENCE: The registered manager has introduced new care plan format for the home. The new format is judged as detailed and information taken is either from needs assessments or previous care plans. Care plans address holistic needs of the people using the service. Care plans are reviewed monthly, one person DS0000022942.V333333.R01.S.doc Version 5.2 Page 10 using the service informed the inspector that he has seen his care plan, but service users surveys informed the inspector that they do not know if they have a care plan, this must be addressed and people using the service must be involved in the care planning process. The home has a large number of people using the service who do speak and read limited English due to their ethnic origin, care plans however do not reflect this and the home should ensure to provide care plans in a user-service friendly format. The inspector noted that health care appointments and visits are recorded and specific guidelines for pressure sore care and catheter care are in place. The General Practitioner is visiting the home regularly and records of these visits have been viewed during this inspection. One visitor informed the inspector informed the inspector that he would like to be involved if a Healthcare Professional is visiting the home and the home should inform family members of these visits. People using the service are regularly seen by dentists and opticians. The home has manual handling risk assessments in place, which have been reviewed if people using the service needs have changed. The inspector viewed weight records of people using the service, but noted that that records are not correct and entries do not relate to the relevant person using the service. The home is providing activities such as exercises and ball games; the home must record if people using the service participate in these activities. The inspector viewed falls assessments in people using the service care plans. The home is using the Nomad system and medication is stored appropriately. Medication Administration Sheet had no gaps and all information was correct. The medication trolley was clean and extra stock is stored in a separate lockable cabinet. The medication fridge was clean and regular temperature records are recorded. Medication is administered by a Registered Nurse and observation made by the inspector demonstrated competency in the medication administration. The medication policy has previously been assessed as compliant. The inspector observed staff treating people using the service with respect and staff demonstrated good knowledge of people using the service care needs. People using the service comments made in surveys are; “I like this home all staff are really loving and caring”. The inspector observed staff using a hoist and noted that people using the service have been covered up to ensure they are moved in a dignifying way. People using the service informed the inspector that they are wearing their own clothes and the inspector noted that all people using the service have been dressed culturally appropriate. DS0000022942.V333333.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and attempts to provide a service that is as individual as possible using its staff and resources. Not all people who use services are consulted on how the home can work to provide them with a flexible lifestyle and activities. Development and progress is limited and reviewing of activities is infrequent. The food in the home is of good quality, well presented and meets the dietary needs of the majority of people who use the service. EVIDENCE: The home is providing a number of activities to people using the service, these activities range from games, exercises, videos, TV, listening to music, etc. An activity plan is displayed in the lounge, which should be provided in a userfriendly format. The inspector was however not fully clear if people using the service participate in activities and clear records must be provided. People DS0000022942.V333333.R01.S.doc Version 5.2 Page 12 using the service informed the inspector that the home is providing activities, but have referred to them, as being always the same and that there is no change. The inspector also noted that staff has been very busy during this visit with toileting and supporting people using the service. The inspector recommends employing an activity co-ordinator to arrange a more stimulating activity programme. The home has regular Bhajan and a small shrine is in the lounge. Volunteers visit people using the service from the local temple for worship. People using the service have received family visits throughout this inspection and people have seen coming and going. Visitors informed the inspector that they are able to visit their relative in their room if they wish to do so. As mentioned earlier volunteers from the local temple visit the home for regular Bhajan. Twelve out of thirteen surveys informed the inspector that they have received enough information about the home before moving in. The family or a representative manages people using the service benefits. The registered manager is holding pocket money for people using the service, records have been changed and updated, but still lack transparency and need to be reviewed again. Personal records are safely stored in a lockable cabinet. The inspector viewed some people using the service rooms and noted that personal belongings have been in these rooms. The home is providing a vegetarian Asian diet, the inspector spoke to people using the service from Muslim faith who informed the inspector that they can have meat, which is brought to them by family members. One family member informed the inspector that his relative is not eating root vegetable due to her religious believe; the home however is not following this. The home must review the procedure and provide food, which is meeting people using the service religious believes. The inspector observed breakfast and lunch, which has been unrushed and food was nicely presented. One survey raised concern that meal times are to close together and does not give enough time to fully digest meals, the inspector suggests to review meal times allowing more time between each meal. The home is providing special diets for people using the service if required. The kitchen is clean, but very dated and the inspector previously recommended refurbishing the kitchen. The home must record the actual fridge and freezer temperature. The home has two menus one for winter and one for summer; the menu is over a two weeks rota. The menu is available in English and must be made available in a people using the service friendly format. Surveys informed the inspector that eight people using the service always like the meals and five usually like the meals. DS0000022942.V333333.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home allows residents to express their views, and concerns in a safe and understanding environment. Links with external agencies are adequate but there is a lack of understanding of safeguarding procedures and how they work. EVIDENCE: The home is recording complaints in detail and the registered manager is following up complaints, and outcomes as well as actions are recorded. The homes complaints policy is compliant with National Minimum Standards. Out of thirteen people using the service surveys received eleven confirmed that they know who to complain to. Staff have received Protection of Vulnerable Adults training and demonstrated knowledge of whom and how to report allegations. The home has Protection of Vulnerable Adults guidelines in place from the funding and the hosting borough; guidelines have been made available for inspection. The inspector noted that social services and the police have dealt with a Protection of Vulnerable Adults allegation made in February 2006, but the Commission for Social Care Inspection has not been informed of this allegation this is required DS0000022942.V333333.R01.S.doc Version 5.2 Page 14 and the home must ensure to report such incidences to the Commission for Social Care Inspection without delay. DS0000022942.V333333.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings. Occasionally there is slippage of timescales and maintenance tends to be reactive rather than proactive. The home is, clean, tidy and smells fresh. EVIDENCE: The registered manager showed the inspector around the home, which was clean and overall nicely decorated. The carpet in the lounge is very worn and relatives informed the inspector that due to people using the service continence issues the carpet becomes very dirty. The home must have the carpet professionally steam cleaned or replaced. Furnishing in the lounge are DS0000022942.V333333.R01.S.doc Version 5.2 Page 16 comfortable and of good working order, they look however very dated and the home should consider replacing furnishing in the communal area. The inspector noted two large cracks in the lounge, the registered manager informed the inspector that these are currently being investigated and are assessed by the insurance to be repaired. The home has a large garden, the fence to the right has been damaged heavily by wind, and the home must replace the fence. The home has a utility room on the first floor and a clothes dryer and washing machine is available. Floors and walls are easy to clean. The home was free of any offensive odours during this inspection. Twelve people service user surveys said that the home is always clean and fresh one informed the inspector that the home is sometimes not clean and fresh. The inspector observed staff cleaning during this visit. The home has two sluice rooms, which were found to be clean during this visit. DS0000022942.V333333.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is proactive rather than reactive in its staffing, recruitment and training. Management prioritise training and facilitate staff members to undertake external qualifications beyond the basic requirements. The scheme introduces internal developmental training, to complement formal training as part of an ongoing training plan. People who use services have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. EVIDENCE: The home provided three staffing rotas with the pre-inspection questionnaire. There is one Registered Nurse and three care staff working during the morning, one Registered Nurse and two care staff during the afternoon and one Registered Nurse and one care staff during the night. The home has a morning and evening cook and one domestic help for five hours during the morning. The inspector is judging the staffing numbers as sufficient to meet the needs of the people using the service currently. DS0000022942.V333333.R01.S.doc Version 5.2 Page 18 The home has 90 of care staff trained to National Vocational Qualification in Care Level 2 or above; this is commendable. Staff informed the inspector that the home is paying for the National Vocational Qualification in Care training The home does not use agency staff and does not employ trainees under the age of 18. The inspector viewed a number of staffing records, which have all been of good standard and all records are compliant with National Minimum Standards. All records included Criminal Records Bureau checks, proof of identification, proof of the right to work in the United Kingdom, etc. Staff is issued with the General Social Care Councils Code of Conduct and terms and conditions and job descriptions are in place. The home is providing an excellent training programme and training records are available. Staff informed the inspector of having received training such as Protection of Vulnerable Adults, Dementia, Infection Control, First Aid, and etc. training records viewed by the inspector confirmed this. All new staff receive a detailed induction, which is recorded and signed by staff and inductee. Staff has been very positive about the support they receive from the registered manager and informed the inspector of having received three supervisions in the past year. DS0000022942.V333333.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. The manager is competent in delivering effective financial planning and budgetary control. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. EVIDENCE: The registered manager Mrs Evelyn Umamaheswaran is a qualified registered nurse with over thirty years experience. The registered manager informed the DS0000022942.V333333.R01.S.doc Version 5.2 Page 20 inspector of having completed her Registered Managers Award. Staff the inspector has spoken to gave very positive feedback regarding support given by the manager. Observations made during this inspection confirmed this and relationships are judged as friendly and with a good sense of humour. The registered manager is fully involved in residents personal care and has one day allocated for admin duties. Staff and residents demonstrated knowledge and understanding of who is responsible and accountable in the home. Residents confirmed that the manager is involved in care and very positive feedback was received. The home has an annual development plan in place and people using the service surveys have been undertaken last year. The home is reviewing the annual development plan and a separate business plan is in place. People using the service surveys received by the inspector demonstrated that service users are listened to. The home has met all but one requirement made during the last inspection. The home has a valid public liability insurance in place and financial records can be obtained from the responsible individual. The inspector viewed the homes business plan, which is reviewed annually. The inspector viewed fire records and certificates such Portable Appliances Test Certificate, Landlords Gas Safety Certificate, etc., which have all been found in order and compliant. The inspector observed staff washing their hands regularly and complying with infection control procedures. DS0000022942.V333333.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000022942.V333333.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 OP7 Regulation 15(1) Requirement The home must ensure to demonstrate clearly people using the service involvement in the care planning process. The registered manager must ensure that people using the service weight records are recorded correctly. The home must record people using the service participation in exercises offered by the home. The registered manger must improve financial records for service users. (The timescale of 28/02/06 has been met partially) 5. OP15 16(2)(i) The home must provide 31/05/07 vegetarian meals to meet dietary needs from people using the service having different religious believes. The registered manager must ensure that actual fridge and DS0000022942.V333333.R01.S.doc Timescale for action 31/05/07 2. OP8 17(3)(a) 31/05/07 3. OP8 17(2) 31/05/07 4. OP14 17(1)(a) 15/05/07 6. OP15 13(4)(c) 15/05/07 Version 5.2 Page 23 freezer temperatures are recorded. 7. OP18 13(6) Allegations of adult protection must be reported to the Commission for Social Care Inspection without delay. The registered manager must have the living room carpet cleaned professionally. The garden fence must be repaired. 15/05/07 8. OP19 23(2)(d) 31/05/07 9. OP19 23(2)(b) 31/05/07 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. 6. 7. Refer to Standard OP7 OP8 OP12 OP12 OP12 OP15 OP15 Good Practice Recommendations The registered manager should provide care plans in a user-friendly format. The home should inform family members and significant others of visits by health care professionals to the home. The registered manager should provide the activity plan in a user-friendly format. The home should have clearer records of people using the service participating in activities. The home should look into employing an activity coordinator to provide more stimulating activities. The weekly menu should be provided in a user-friendly format. The home should review mealtimes to allow more time between meals. DS0000022942.V333333.R01.S.doc Version 5.2 Page 24 8. OP15 The kitchen should be redecorated. (Previously Recommended) 9. OP19 The home should consider replacing furniture in the lounge. DS0000022942.V333333.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 DS0000022942.V333333.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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