Inspection on 04/07/06 for St Lukes Care Home

This inspection was carried out on 4th July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Lukes Care Home 16/12/09

St Lukes Care Home 11/12/07

St Lukes Care Home 23/09/05

St Lukes Care Home 24/05/05

St Lukes Care Home 11/10/04

St Lukes Care Home 26/04/04

St Lukes Care Home 09/03/04

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

CARE HOMES FOR OLDER PEOPLE St Lukes Care Home Palace Fields Avenue Palacefields Runcorn Cheshire WA7 2SU Lead Inspector Anthony Cliffe Key Unannounced Inspection 08:15 4 and 5th July 2006 th 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 St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Lukes Care Home Address Palace Fields Avenue Palacefields Runcorn Cheshire WA7 2SU 01928 791552 01928 712072 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) www.c-i-c.co.uk. Community Integrated Care Care Home 60 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (60), Learning disability (2), Physical disability of places (2) St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 60 service users to include: * up to 60 service users in the category of DE(E) (dementia, over the age of 65 years) * up to 10 service users in the category of DE (dementia, under the age of 65 years) * 2 named service users in the category of PD (physical disability, under the age of 65 years) * 2 named service users in the category of LD (learning disability under the age of 65 years) diagnosed with dementia 23rd September 2005 Date of last inspection Brief Description of the Service: St. Luke’s is a purpose built establishment for the provision of nursing care for up to sixty residents diagnosed with dementia inclusive of 2 places registered for physical disability. This service is provided within four separate units located over two floors, each unit has its own lounge, dining room, utility kitchen and staff team. Each unit provides accommodation for a maximum of 15 residents. The design features include passenger lifts, safety alarmed exit doors, single level flooring with external access, grab rails, and adaptations in all communal areas, bathrooms and toilets. Externally there is a central patio area and sensory garden accessible to all residents. St Luke’s is located in a large residential area on the outskirts of Runcorn. The home is on a main bus route and rail links are within two miles of the home at Runcorn East station. The service is provided by Community Integrated Care, a not for profit organisation. Fees range from £330 to £500 per week. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A regulatory inspector undertook this unannounced site visit. The Key inspection was arranged as part of the Commission for Social Care Inspection’s (CSCI) regulatory programme under Inspecting for Better Lives. The site visit took place over 13 hours. Feedback was given to the manager. Records were inspected and staff practice was observed. Discussion took place with residents, visitors and staff. A tour of the premises was undertaken. Information was collected from a pre inspection questionnaire and people who returned questionnaires sent out by the CSCI. What the service does well: What has improved since the last inspection? The leadership of the staff team has improved by a motivated manager, which has improved staff morale. Two deputies that take the lead roles in monitoring staff practice and training support the manager. Care planning, risk assessment and risk management of residents who present challenging behaviour has improved. The staffing ratio on the four units has improved with additional staff on duty most days. Staff training and understanding of managing challenging behaviour has improved and relatives and staff comments support this. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 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. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives. Residents’ needs are assessed prior to moving in. EVIDENCE: Residents were not routinely provided with a copy of the statement of purpose, though a copy of this was available in the foyer and on individual units. There were copies of contracts on file for those residents whose files were examined. Records were examined of the resident who most recently moved into St Luke’s. Due to the aggressive behaviour of the resident in hospital the pre admission assessment was updated prior to moving in. From the information obtained pre admission an initial care plans to orientate him to a new environment and for staff to recognise the behaviour that indicated his mental health was deteriorating had been completed. This advised staff on how to communicate with the resident and recognise triggers to aggressive behaviour. Information had been provided on the mental health monitoring arrangements from the community mental health team and his social worker had completed a detailed risk assessment and safety plan to follow should the resident need to return to hospital. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to the service. Residents’ plans ensure their health and social care needs are recorded, reflect residents’ needs and are reviewed regularly. Medicine management and administration is safe. EVIDENCE: Five care plans showed that a wide range of assessment documents were completed; with a care plan to address residents’ needs. From looking at care plans, observing staff working practices and talking with residents, staff and visitors the health needs of residents were generally met. There were several examples of good practice regarding the care of residents and recording of personal, social and health care. On moving into St. Luke’s an initial care plan was developed for a resident on managing potentially challenging behaviour. This incorporated a detailed social assessment of his life prior to hospitalisation. A detailed risk assessment and safety management plan was in place that guided staff on the use of de-escalation techniques should they observe triggers to aggressive behaviour. This included the use of his favourite foods, music and drinks. It recorded staff should not attempt to touch the resident as it would be perceived as a personal attack. No incidents of aggression had been recorded. The resident’s records noted he had been registered with a General Practitioner, referred for a continence assessment and a dietician assessment. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 10 Another resident’s risk assessment and safety management plan had been amended following a recent review of his care under the vulnerable adults procedure. These identified the resident required constant discreet observation and two staff to attend to his personal care needs. Another resident’s care plan had been reviewed following an aggressive incident with another resident. The resident had been frightened following the incident. This was referred under the protection of vulnerable adults procedure by staff. A safety management plan was introduced to ensure the resident was discreetly observed when another resident was present so her personal space was not invaded. Another resident’s behaviour had been challenging and her mental health was reviewed following a number of aggressive incidents with other residents. Following this her social worker devised a detailed risk assessment as she was subject to the Care Programme Approach for mental health. Staff said they were aware of the safety plan to follow in managing the resident’s aggressive behaviour. Staff said they had read this or the content had been shared during handover. There was evidence that the resident had been referred to the falls prevention services following deterioration in her health and hip protectors supplied. She was seen by the dentist for new dentures and dietician following weight loss. This resulted in a weight gain as she was eating better and having dietary supplements. A student nurse shared her knowledge of a resident and said she contributed to the care plan. She said that sometimes staff did not respond to the resident’s repeated requests and this added to his agitation. She said this was rare and generally staff communicated with him very well. The manager said the student nurse had a very good relationship with the resident and had recognised good practice in communicating with him. This information was to be added into the plan by the student. She described how she had supported residents’ equality in completing the CSCI ‘Have your say about’ questionnaires sent to residents. She said she supported the residents in completing the questionnaires using her knowledge and understanding of the way they communicated and ability to understand the questions. Their comments where possible were recorded. Residents commented they had help in arranging to move into St.Luke’s, enjoyed singing and reminiscence groups and would like to have the sports channel on SKY television. A resident commented ‘I think I’m better of here as I’m getting older’. Medicines management and administration was examined. Only some minor errors were noted on medicine administration records where a signature for the administration had not been recorded. Medicines audits done by the manager had highlighted the error and the manager confirmed the staff member had been identified and the matter would be discussed in supervision. The registered nurses complete daily audits of medicine administration and must sign to verify they had completed these. The daily audit did not include a visual check of the monitored dosage system to ensure all medicines were administered. See recommendation 1. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Residents are supported in making choices in their lifestyle and social activities needs so they have control over their lives. Residents have a choice of meals in pleasing surroundings but the ordering and recording of meal choice could be improved to reflect residents’ choices. EVIDENCE: The social care element of residents’ care plans had been reviewed and recorded regular participation in social activities by residents. St.Luke’s employs two activities coordinators who work sixty hours a week. They work mainly in the week but the manager said their hours were flexible and included evenings and weekends where necessary. Each unit had a programme of activities displayed. The activities coordinators were seen baking with residents and playing bingo on the first day of the site visit. On the second day a day trip out was arranged. Two residents have their own staff and care package for social activities. The staff said they could access transport when necessary but would like the residents to have their own transport and not be dependent on the homes mini bus. The manager said this matter was discussed continually with the authorities that funded the residents’ care. Staff said they had taken the residents swimming and for days out recently. Relatives were complimentary about the social activities programme and standard of care provided by staff. A relative said ‘ my husband likes to stay in his bedroom, he can be noisy and this irritates another resident, so it protects him. Staff put on St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 12 his classical music and this relaxes him. I attend the relatives meetings they are very good. You can raise things and say what you feel. Action is always taken. The activities staff runs the meetings. They are exceptional and always there for you’. Another relative said ‘ they still promote my wife’s modesty and encourage her to use the toilet. Staff let me know about everything. They are friendly and offer me drinks and meals if I want to have one with her. I come to the relatives’ meetings. The two activities ladies are superb and I can’t speak highly enough of them. My wife still enjoys music and dancing and when they get an entertainer in they encourage her to get up and join in the dancing. The grandchildren visit and they join in. We went to Chester zoo a few weeks ago. There are lots of things going on all the time. I can join in and they like you to be involved. When there are big events more of the family come. Before she moved in I was given a brochure telling me all about the place. They showed me her care plan, which followed on from the social services one and asked if I agreed with it. This is updated and I see it. It was done last month’. A resident was sat in the enclosed garden and said how much she enjoyed the peace and quiet of it and could sit and watch the birds. Residents were seen having breakfast and lunch. Residents said they could choose meals. One resident said ‘ I had a lovely breakfast this morning cereal and cold milk because it’s so hot. They give me plenty to eat and drink and are always asking if I want a drink. It’s very reasonable and they don’t charge for anything’. Another resident said ‘I had sausage, bacon and tomatoes this morning it was lovely’. The choice of lunch was difficult to ascertain, as the units did not have copies of menus on them. The manager said white dry wipe boards had been ordered to tell residents about the choice of menu. Staff interviewed said ‘ we don’t know what’s for lunch until it comes up. It’s difficult to get people to choose if they can’t tell you. We ask them what they want and offer something of the alternatives menu. Everyone had chips, egg and mushy peas today. We can send to the kitchen for sandwiches. We don’t record people’s choices, as we don’t have a menu. The only difference is the pureed diet, same meal but pureed’. Another staff member said ‘we don’t use a menu board and stopped using order sheets. An alternatives menu is on offer otherwise residents get what they are sent from the kitchen. We don’t have a copy of the menu’. Information had been produced on the report form the CSCI on meals and meal times tilted ‘The Highlight of the Day’. From this report Community Integrated Care had produced guidance on menu and meal provision giving a varied menu choice including choices based on dietary, ethnicity and religious preferences. There were pictorial menus for homemade meals, soups and sweets. The revised menu is to be introduced within the near future. See recommendation 2. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Complaints are acted on appropriately. An informed staff group and manager protect residents from abuse. EVIDENCE: Complaints records noted that one complaint had been received and the CSCI were aware of the complaint. The complainant was contacted by telephone to discuss how the complaint was handled. The complainant said, “Initially when he moved in we were not welcomed they did not follow the policy that was in place. He also fell and they did not inform me. They now do this and notify me of everything. The have provided him with a wheelchair to use and we can push him around in this. The complaint was responded to positively. What I asked for was done. I have asked for him to be walked around more and they do this. They also protect him from another resident”. Each unit had the community integrated care flow chart for staff to follow should an incident of abuse arise. Staff referred to this when adult protection was discussed. A relative said he had been informed about his wife being hit by a resident and the matter referred under the local adult protection procedure. He said “ I was satisfied they did everything to protect my wife, the resident was moved to hospital”. He said that he had seen an improvement in the way staff communicated with residents. He said, “ I get the Alzheimer’s society magazine. The say there is a method of talking to people that diffuses situations. I talked to the manager about this as they use it. There is a much calmer atmosphere using the talking method and less injuries to staff”. A new member of staff said she had experience of working in a dementia care home and had undertaken training that helped her to communicate more positively St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 14 with residents. She said “ the training I had advised you to use closed questions. I see other staff here using the same skills and have had the same training and doing it. It’s good practice and is written in the resident’s care plan. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is assessed as good. Residents live in a safe and well-maintained environment. EVIDENCE: The building had had a major refurbishment in 2005. The décor had been enhanced as matching furniture and curtains were purchased. All public area and communal areas were clean and odour free. A fulltime housekeeper had been appointed and made routine visits around the building to ensure it was clean. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. The numbers, training and skill mix of staff are adequate to meet residents’ needs. Staff recruitment ensures residents are protected. EVIDENCE: St.Luke’s provides one trained member of staff and three care staff between the hours of 8am to 8pm on each unit most days. On nights there is one trained nurse and three care staff to each floor. Information provided by the registered manager was that twenty-nine out of fifty two staff had an NVQ level 2 qualification and thirteen staff were undertaking one. Three staff files were looked at. All contained appropriate identification documentation and completed Criminal Record Bureau disclosures. All files had two written references. There was evidence of induction and training on staff files. The registered manager had completed a training plan for the staff team. This showed what training had been done and what training was planned for the future. It also indicates who is a qualified trainer. The manager had devised a training matrix to record which staff had training and when it was next due. It recorded staff had undertaken training appropriate to their role. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is assessed as good. This judgement has been made using available evidence including a visit to this service. Quality assurance ensures smooth management of St.Luke’s. Financial procedures safeguard residents. The maintenance of the building and equipment ensures the safety of residents. EVIDENCE: The process for registration as manager was near to completion with a ‘fit person’ interview arranged with the manager. No personal monies other than personal allowances were held on behalf of residents. Relatives were billed directly for additional services such as chiropody or hairdressing. Residents’ personal allowances were safely secured and records for credits and debits maintained. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 18 Quality assurance was robust with the introduction of a monthly ‘care standards review’ audit, which commenced in May 2006. This looked at the management of systems used at St.Luke’s by examining the documents used and audits completed by the manager to verify the evidence in them. An example of this was staff meetings taking place and minutes being made available. Information provided by the manager in a pre inspection questionnaire was examined and portable electric appliance testing, water chlorination and maintenance and testing of fire equipment completed. St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 2 X 3 X 3 X X 3 St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations Medicine audits should contain a visual check on the monitored dosage system to ensure medicines are administered to residents and cross-referenced as signed as given. Menus should be available in formats that allow residents to choose their meals where appropriate and their choices recorded. 2. OP15 St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 St Lukes Care Home DS0000005148.V294915.R01.S.doc Version 5.1 Page 22 - 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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