Inspection on 05/10/05 for St Stephens Residential Home

This inspection was carried out on 5th October 2005.

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

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

Other inspections for this house

St Stephens Residential Home 07/08/06

St Stephens Residential Home 22/06/05

St Stephens Residential Home 03/11/04

St Stephens Residential Home 30/06/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

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Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE St Stephens Residential Home St Stephens Terrace Droitwich Road Worcester Worcestershire WR3 7HU Lead Inspector Andrew Spearing-Brown Unannounced Inspection 5th October 2005 10:00 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 Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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 Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Stephens Residential Home Address St Stephens Terrace Droitwich Road Worcester Worcestershire WR3 7HU 01905 29224 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) Partnership Care Services Mrs Susan Elizabeth Finbow Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51), of places Physical disability over 65 years of age (51) St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2005 Brief Description of the Service: St Stephens is registered to provide accommodation and care for 51 older people who may also have needs relating to physical disabilities and/or a dementia illness. A specialist dementia service is not provided. However care can be offered to people who have mild to moderate dementia care needs. The home is situated on the outskirts of Worcester city, close to local amenities. The building was upgraded and refurbished in 1999. It is a large three-storey building with a shaft lift to enable easy access between floors. There are 43 single bedrooms, 21 of which have ensuite facilities, and 4 double bedrooms, all of which have en-suite facilities. All bedrooms meet or exceed the National Minimum Standards (Older People) for usable space. There is a wide choice of communal lounges and dining areas and all rooms are well fitted and furnished. St Stephens has an attractive level central garden. The home is owned by Partnership Care Services who is referred to in this report as the registered provider.Mrs Susan Finbow who is referred to in this report as the registered manager manages the home. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a six-hour period from mid morning till mid afternoon. The previous inspection, which was also unannounced, took place during June 2005. A follow up inspection visit was undertaken in July 2005 by the lead inspector and a pharmacy inspector. The follow up inspection took place due to a number of serious concerns in relation to the management, administration and recording of medication during the June inspection. The main focus of this inspection was to assess the progress made in relation to the requirements from the previous inspection as well as the follow up inspection. In addition some of the key standards were inspected. A number of standards have not been inspected during the current inspection year but will be as part of future inspections On the day of this inspection the registered manager was on duty in the afternoon. The deputy manager was on duty during the morning and assisted with this inspection. During the inspection a small number of carers were consulted as were a representative number of residents. Certain areas of the home were seen including some bedrooms and all communal rooms. The care records of a sample number of residents were seen. Other documents seen included medication records, some staffing records and some health and safety records. What the service does well: Residents consulted were generally positive about the meals provided within the home. Staff were observed affording residents respect with regard to their privacy and dignity. Activities and outings are provided to stimulate residents. Although this inspection took place in early autumn the grounds, especially the centrally patio area, continue to be attractive. The home recently won an award as part of the Worcester in Bloom competition. All areas of the home were clean and tidy; residents’ comments were as in the past positive about the cleanliness of St Stephen’s. All residents’ bedrooms that were seen were personalised. Communal lounges are well furnished and comfortable. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 6 A significant emphasis is placed on mandatory staff training. The majority of staff have received training regarding the recognition of adult abuse. Over 50 of care staff hold a NVQ (National Vocational Qualification) level 2. What has improved since the last inspection? 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 Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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 Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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, 3 and 5. Standard 6 is not applicable. Written information is available for potential residents and their representatives to assist them make a decision about the home. Relevant information is available to provide an initial care plan EVIDENCE: The file of a recently admitted resident evidenced that an assessment is carried out prior to individuals moving into the home. Potential residents are furthermore able to visit the home prior to their admission, which is initially on a trail basis. Residents are provided with a ‘Welcome Pack’, which contains the homes statement of terms and conditions. Intermediate care is not offered at St Stephen’s and the home has no plans to provide such as service. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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 Some progress has been made with regard to the administering and recording of medication however serious concerns remain. In addition systems to up date care plans failed to ensure that the health care needs of all residents are appropriately identified and met. These shortfalls potentially leave residents at risk. EVIDENCE: Residents care plans are held on computer. Terminals are available within the office and the ‘treatment room’. Paper copies of care plans can be generated. As part of this inspection a small number of care plans and daily notes were viewed on one of the computers. The daily notes of three residents were viewed. The terminology used within these notes had significantly improved since the last inspection. Furthermore it was evident that matters needing to be followed up, such as seeing a district nurse or doctor, were suitably actioned. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 10 Following the previous inspection the home was required to improve care planning in a number of areas. The care plans viewed had a number of shortfalls. In addition risk assessments, which need to be referred to by care staff, had similar shortfalls. The care plans seen did not use all the headings as listed under standard 3.3 of the National Minimum Standards, however these titles are available should they be required. The information upon the care plans seen was scant in its detail and fails to effectively specify the care activities and the interventions required by care staff to meet individual needs. From the information upon care plans it would not be possible to fulfil the current care needs of residents and therefore placing an over reliance on staff knowledge and memory. The care plan of a poorly resident was not up to date in that it failed to indicate the changing care needs. The care plan of a respite resident stated ‘no history of falls’ however an assessment indicated otherwise. Some information regarding likes and dislikes regarding food was seen but no nutritional risk assessments were seen. Information was seen regarding a specified request however this was not transferred on to the care plan. Sit on scales are available. The recording of residents weight within care plans needs to be consistent. Following the inspection in June 2005 a notice of serious concern was issued this was followed by a letter setting out a number of immediate requirements to the registered provider and registered manager. A follow up inspection was undertaken in July 2005 by the lead inspector and a pharmacy inspector. The follow up inspection noted a number of improvements however further improvements remained. As part of this inspection a comprehensive inspection of the medication system took place. It was pleasing to note some improvements in the overall management of medication especially controlled drugs, which were found to be in order. In addition the MAR (Medication Administration Record) sheets contained information about any known allergies or when none are known this information was recorded. Variable dosages were suitable recorded. A new fridge is in place and suitable records regarding its temperature were available. Despite these improvements serious concerns remain requiring the issuing of a further notice of serious concern. As these areas are similar to those identified before the registered provider needs to be aware that the Commission for Social Care Inspection may consider enforcement action if failings continue. A letter informing the registered provider of the serious shortfall was issued. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 11 Since the last inspection the registered manager has introduced an improved system for recording the application of creams and ointments as well as the administering of medication carried out by care staff such as eye drops and inhalers. This system involves signing a photocopy of the master MAR sheet. Shortfalls were however noted on these sheets. Some gaps were noted whereby the application of cream or the administering of prescribed medication was not signed as given or no code was entered if omitted. Amendments had been made to these copied MAR sheets, which was not transferred to the master sheet. Additional errors were also found in relation to creams and ointments. On examining the main MAR sheets it was noted that they were generally fully completed however some gaps noted were in relation to medication from the evening prior to this inspection. However it was of serious concern to discover medication remaining within the MDS (Monitored Dosage System) blister pack, which had been signed on the MAR sheets as administered by a senior member of staff. On one MAR sheet it was not possible to ascertain why an antibiotic was described as ‘stopped’ as no reference was able to be found when cross referencing to other documents such as care plans or medical records. Since the previous inspection care staff have received some training on the use of the medication system. Whilst an accredited trainer delivered this training, it only partially meets the requirement and is not sufficient. The medication keys were held on a key ring with all other keys such as those to cleaning cupboards. As a result staff that would not have authorised access to medication including controlled drugs had unrestricted access to the keys and therefore potentially could gain access to medication. The registered manager undertook to take immediate action to implement a procedure whereby senior staff sign for the keys. The medication policy and associated procedures were not viewed as part of this inspection. Staff were observed to have regard for residents privacy and dignity by means of knocking on bedroom doors and waiting for an answer before entering. A pay phone is available for residents use. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Activities are provided to stimulate people living in the home. EVIDENCE: A range of activities are arranged for residents to partake in. These activities can be evidenced via notices on display of forthcoming events and from the regular reports prepared on behalf of the owner that are forwarded to the CSCI. Forthcoming events include a quiz morning, a coffee morning, aromatherapy, a Halloween party, a bonfire party and a trip to Walsall lights. Meals were assessed as part of the previous inspection. No meals were seen as part of this visit although it was noted that residents were able to have a slice of cake with their afternoon cup of tea. A member of the care team was seen to be taking requests for tea, for which there was a choice of kippers or soup and assorted sandwiches. The overall consensus from residents was that the food offered was good on the majority of occasions. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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, 17 and 18 Suitable training in relation to adult abuse procedures assists in the protection of vulnerable persons. EVIDENCE: The majority of staff have attended training upon the recognition of abuse and of reporting such matters. A training officer at the homes head office is sorting training for these who either missed the training or have commenced duties since it took place. It was reported that all members of staff have received a copy of a booklet recently issued by Worcestershire Social Services upon abuse. Information regarding a local advocacy service was displayed throughout the home. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 14 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, 20, 21, 22, 23, 24, 25 and 26 Improvements continue to take place in the standard of the environment to ensure that residents have a safe and comfortable place to live. EVIDENCE: The gardens, especially the back garden continues to look attractive despite the start of the autumn. Suitable shaded seating is provided. As in the past St Stephen’s has recently won an award in the Worcester in Bloom competition. Communal facilities are spacious, varied, comfortable and attractive. Residents infrequently use the lounge on the top floor. A small smokers’ lounge is provided; smoking is not permitted within individual bedrooms. Lounges on the ground floor and corridors were decorated earlier this year; since the last inspection additional areas have been painted and look bright and welcoming. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 15 This inspection took place during a cooler spell in the weather. The vast majority of the home was sufficiently warm. The entrance hall was cool these comments were shared by a couple of residents, however this area contains a lot of glass as well as the front door. Since the last inspection the home has purchased a new tumble drier. The washing machines within the laundry are suitable for the needs of residents. They both have a sluice facility. It is believed that the machines meet the Water Supply (Water Fittings) Regulations 1999. The laundry is suitable for purpose and has hand-washing facilities. Communal bathing and toilet facilities within the home possessed liquid soap in line with infection control policies provided by Herefordshire and Worcestershire Health Authority. Similar to the last inspection residents consulted commented upon the cleanliness of the home. No offensive odours were detected throughout this inspection. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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 and 29 Procedures for the recruitment of staff are sufficiently robust to ensure the protection of residents. EVIDENCE: A copy of the staffing rota was in the office; this however was not checked on this occasion. St Stephen’s has on occasions needed to rely on agency staff. It was evident that a recent recruitment round was successful and the majority of posts were filled. Residents consulted spoke highly of the staff team, comments included: ‘can’t fault them’ ‘all very friendly’ Out of the current care team 56 are qualified to NVQ (National Vocational Qualification) level 2. In addition to these persons a further 4 carers are working towards their award. A member of staff consulted confirmed that she received regular supervision. The staff files for two newer members of staff were viewed these demonstrated that all the necessary recruitment checks to ensure the protection of residents had taken place. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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): 33, 36 and 38 Records seen demonstrated a high regard for health and safety however the failure to have fire-fighting equipment serviced within the last twelve months could have placed residents and others at risk. EVIDENCE: Under Regulation 26 of the Care Homes Regulations 2001 the registered provider or a representative is required to visit the home at least once per month and write a report. Copies of these reports are routinely sent to the local office of the CSCI. A certificate showing that the required level of public liability insurance is in place was displayed, as is the certificate of registration. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 18 It was noted that the annual inspection of fire fighting equipment last took place during August 2004 therefore over due by over a month. A brief viewing of the fire log indicated that the required weekly and monthly tests or visual checks of the system and equipment takes place. The majority of staff have received the required mandatory training in areas such as fire awareness, moving and handling, first aid and food hygiene. St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 X 2 St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 20 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 Requirement The registered manager must ensure that the service user’s care plan sets out in detail the action which needs to be taken by care staff to ensure that all aspects of need are met. (Previous timescale of immediate and on going not met). 2 OP7 15 (2) (a) The registered person must ensure that care plans are reviewed on a monthly basis or more frequently to reflect the changing care needs of service users. (Previous timescale of immediate and on going not met). 3 OP8 14 17 (1) (a) S3 The registered manager must ensure that a nutritional risk assessment is in place in addition to a list of likes and dislikes. 30/10/05 05/10/05 Timescale for action 05/10/05 St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 21 4 OP8 12 (1) The registered manager must ensure that risk assessments in relation to pressure care prevention are carried out. (Previous timescale of immediate and on going not met). 05/10/05 5 OP9 13 (2) The registered manager must ensure that medication administration records are completed adequately and at the time of administration. 05/10/05 6 OP9 13 (2) (Previous timescale of immediate and on going within the last two inspection reports not met). The registered manager must 05/10/05 ensure that the reason why medication is stopped or amended must be recorded within care records in order that a full audit trail can take place. The registered manager must ensure that prescribed items are administered in line with the instructions given by the medical practitioner. The registered manager must ensure that the keys to the medication trolley and cupboards are held upon a nominated person and not available to unauthorised persons. The registered provider must ensure that all staff involved in the administering of prescribed medicines receive appropriate accredited training The registered manager must audit the records of all items deposited by service users for safekeeping to ensure all items are suitably recorded as held. DS0000018676.V255520.R01.S.doc 7 OP9 13 (2) 05/10/05 8 OP9 13 (2) 05/10/05 9 OP9 13 (2) 30/11/05 10 OP35 17 (2) S4 (9) 30/11/04 St Stephens Residential Home Version 5.0 Page 22 (This standard was not assessed as part of the inspection carried out on 5th October as the documentation was not available. The timeframe previously set remains - this requirement will therefore be reassessed as part of a future inspection). 11 OP35 17 (2) S4 (9) The registered provider must develop suitable policies and procedures in relation to items held in safe keeping which are unclaimed by the rightful owner. (This standard was not assessed as part of the inspection carried out on 5th October as the documentation was not available. The timeframe previously set remains - this requirement will therefore be reassessed as part of a future inspection). 31/12/04 12 OP38 23 (4) (c) The registered manager must ensure that routine servicing of fire fighting equipment takes place every 12 months. 05/10/05 St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Stephens Residential Home DS0000018676.V255520.R01.S.doc Version 5.0 Page 25 - 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. 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