Inspection on 01/11/06 for The Elms [Staunton]

This inspection was carried out on 1st November 2006.

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

The inspector 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

The Elms [Staunton] 18/02/08

The Elms [Staunton] 15/10/07

The Elms [Staunton] 14/11/05

The Elms [Staunton] 24/05/05

The Elms [Staunton] 11/01/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Elms Staunton Coleford Glos GL16 8NX Lead Inspector Mr Adam Parker Key Unannounced Inspection 1st November 2006 09:00 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 The Elms DS0000062586.V313559.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. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address Staunton Coleford Glos GL16 8NX 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) 08453 455793 01594 837681 Brickjet Ltd Mrs Nicola Louise Warman Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate a named 41yr old female service user. This arrangement must be reviewed by the CSCI after 3 months from the date of agreement should the service user still be living at The Elms. 14th November 2005 Date of last inspection Brief Description of the Service: The Elms is situated alongside the main road between Coleford and Monmouth in the Forest of Dean. The home is owned and managed as part of the Blanchworth Care group. The purpose built building is registered to accommodate 31 residents over the age of 65 years, who require personal and nursing care. The building is constructed on four-levels, has a shaft lift, and access to the building is ramped for wheelchair users. The ground floor accommodates the main office, reception, kitchen and laundry room. On the first floor, there is a large lounge/dining room and two smaller lounge areas, one being a pleasantly appointed conservatory. The upper floors have bedrooms, bathrooms and additional toilet facilities. All thirty-one rooms offer en suite facilities, with a hand basin and toilet. All rooms offer single accommodation. Spacious gardens surround the home and provide a pleasant area for residents to sit when the weather allows. Current fees are £390.25 to £630.00. per week.Hairdressing, chiropody, escort and personal toiletries are charged extra. The home makes information about the service, including CSCI reports available to service users through a service user guide and statement of purpose available in the home. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was carried out by one inspector over six hours on one day in November 2006. The registered manager of the home was present for the inspection visit coming in from home on her day off. Two service users were spoken to as well as three relatives. The inspection visit consisted of a tour of the premises and examination of service users care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A number of service users were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Eight Comment cards were received from General Practitioners (GP), two from relatives of service users, eight from service users although none were received from staff working in the home. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home has been well managed to provide good outcomes for service users. Systems are in place for assessing service users’ needs and planning care with their involvement where appropriate or that of their relatives. Care plans are subject to regular review and ongoing evaluation. Care is delivered in such a way as to uphold service users’ privacy and dignity. A range of activities are on offer for service users and some of these involve links with the local community. Mealtimes cater for individual needs and choices both in terms of the meals on offer and where service users choose to take their meals. The home was well maintained and clean providing service users with a safe and comfortable environment. The home has robust recruitment procedures and has a programme for providing induction and ongoing training to staff. The registered manager is nearing completion of the registered managers award qualification. She has worked hard to provide good outcomes for service users in the home. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 6 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. The Elms DS0000062586.V313559.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 The Elms DS0000062586.V313559.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s admission procedure ensures that all service users are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: The assessment documentation for one service user recently admitted to the home was looked at. This had been completed following an assessment of the service user’s needs by the registered manager prior to admission to the home. Another recent admission to the home had an assessment completed ten days prior to admission and the home had obtained a comprehensive hospital discharge summary and a copy of the assessment completed by the funding authority. In a discussion with the registered manager, examples were given of referrals to the home where admission had not taken place. The reason for this being that the home felt they were unable to meet the needs of the individuals, one The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 9 being due to needs associated with dementia. Copies of the assessment documentation for these prospective service users was seen. The home does not provide intermediate care and so Standard 6 does not apply. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is an individualised care planning system in place which provides staff with the information they need to meet service users’ needs. Service users’ health needs are met through access to and liaison by the home with health care professionals. Medication administration systems promote service users’ health with improvements in storage planned by the home. Care is given in such a way as to promote the privacy and dignity of service users. EVIDENCE: Care plans were individualised and covered a wide range of service users needs. There was evidence that both service users and their representatives had been consulted on care plans to obtain their agreement. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 11 Care plans were linked into the outcomes of risk assessments that had been completed for such issues as pressure sores, malnutrition, manual handling and the use of a reclining chair. Risk assessments had also been completed for heat exhaustion during the summer following national guidelines. Where there were wounds, evaluation charts had been completed as well as dressing protocols. One service user had returned to the home from a stay in hospital where she had developed pressure sores, these had been recorded by the home on a body chart. There was evidence of monthly review of care plans and in some cases this was carried out more frequently. The relative of one service user who required assistance with all personal care commented that the service user was always “clean and well shaven”. One service user was prone to chest infections and a care plan had been drafted to address this health care need. Another service user had a care plan for mental health needs. Records were kept of GP visits and there were some examples where GPs had completed their own entries in the care plan file. A record was also held of chiropodists’ visits to service users. Several GPs had made comments to the Commission in inspection surveys about problems getting through to the home on the telephone. This issue was discussed with the registered manager who was aware of the problem and was considering whether more telephones should be installed at different locations within the home. Medication was stored in a number of locations in the home and the registered manager described plans to centralise this in the near future. Storage temperatures were being monitored in the medication refrigerator and in one other location. If there is any delay in centralising the medication storage then it is recommended that temperatures are monitored in all storage locations. The medication administration sheets were examined and found to be in good order with photographs of service users included in the administration chart folder for identification purposes. The registered manager carries out regular audits on the medication administration record charts. It was noted that where handwritten entries had been made these were dated and signed by two members of staff. One service user was making use of an ‘alternative’ remedy for treating pressure sores and there was a record that this had been agreed by the GP. Care was observed being given in way that promoted service users privacy and dignity. Staff knocked on doors before entering bedrooms and toilets. It was noted that one service user had a key to their bedroom and the registered manager stated that this was provided following a risk assessment. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a range of activities inside and outside of the home and in doing so maintain some links with the local community. Service users are able to benefit from exercising some control over their lives within the limitations of their individual abilities. Service users’ dietary needs are well catered for taking into account their personal needs and choices. EVIDENCE: Examination of care files showed that service users had information recorded on lifestyle and interests, with one service user this information had been completed by a relative. The home offers a range of activities inside of the home and a weekly programme is displayed on a notice board. As notified a game of darts was taking place on the morning of the inspection visit and bingo in the afternoon. A Halloween party had recently been held in the home and a relative of a service user commented positively on this. Other activities in the home include visits from a musical entertainer and visits from a pet dog. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 13 Service users’ spiritual needs are met through Holy Communion held in the home on a monthly basis and a regular visitor for service users of the Jehovah Witnesses faith. The registered manager reported that in the past service users had visited the local church for a flower festival and had attended events held in the village. There were plans for a pantomime to be held in the home nearer Christmas as well as a carol service. During the inspection visit a number of visitors were seen in the home visiting service users in both communal areas and in their own rooms. The home has information about local advocacy services and the registered manager gave an example of when this was used for a service user in the past. Examples of service users’ personal possessions was seen in their rooms during the inspection visit including furniture. At the time of the inspection there were no service users in the home handling their own financial affairs. Meetings with relatives and service users have been held and the home has a regular monthly meeting just with service users’ relatives. Service users are entitled to see records held about them by the home and the registered manager gave an example of one service user who is given access to her records when she requests. Lunch was observed being served during the inspection visit. Tables were laid in an attractive manner and it was evident that some service users chose to sit in groups treating the meal as a social occasion. Other service users took their meals in their rooms or on tables where they sat in the lounge area according to their preference. Service users took drinks with their meals including alcoholic drinks. Special diets provided were a diabetic diet and a soft diet. One service user was having a pasta dish as an alternative to the meal on offer. The soft diet was presented with the individual parts of the meal served separately on the plate. One service user had information recorded about personal preferences around mealtimes, such as having a sherry before lunch and eating privately in their own room. The relatives of another service user reported that she “loved the food” and the service user stated that the food was “very good”. In surveys received from service users, four stated that they always liked the meals in the home, three stated that they usually liked the meals and one that they sometimes liked the meals. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a clear complaints procedure available to service users and their representatives with some evidence that complaints are acted upon in service users’ interests. The home has policies and procedures that linked with staff training should ensure that service users are protected from abuse. EVIDENCE: The home has a clear and accessible complaints procedure and keeps a log of any complaints made to the home. At the time of the inspection one complaint was under investigation and the registered manager reported that the complainant was happy with the outcome of the investigation so far. The home has robust procedures for responding to suspicion or evidence of abuse. In addition staff receive training on abuse and challenging behaviour on a biannual mandatory basis. It emerged during the inspection visit that although most staff had received abuse training there were a few staff that had not. The provider views this training as mandatory and so any staff who had not attended the training would be followed up. The home was currently dealing with one issue regarding the use of restraint in the home. The Elms DS0000062586.V313559.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have the benefit of living in a well maintained and clean environment. EVIDENCE: A tour of the premises was conducted with the registered manager. The environment was found to be clean and well maintained. Eight survey forms were received from service users in the home and they all stated that the home was always fresh and clean. The home has the benefit of a maintenance man who lives near by. He was able to swiftly respond to a request by the registered manager to attend to a dripping overflow pipe outside of the home and to remove a cracked unit above a sink in one of the bathrooms. Outside of the home there is a large enclosed elevated patio area which may be enjoyed by service users in fine weather and photographs of this were on The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 16 display in the home. The registered manager described plans for the construction of raised garden beds for service users to grow flowers and vegetables. Service users’ rooms were personalised with their own possessions and in some cases furniture. The registered manager described how an audit had recently taken place of bed linen with replacement items ordered where needed and evidence of this was seen. In the laundry a gap in the flooring had been covered by tape which was in need of replacement. This was carried out during the inspection visit although the home should consider finding a more permanent solution. Apart from this issue the laundry was in good order with hand washing facilities available. The Elms DS0000062586.V313559.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The numbers of care staff ensure that service users needs are met. The level of NVQ training needs improvement to ensure that service users are in safe hands. Service users are protected through robust recruitment procedures. Induction and foundation training should ensure that staff are trained and competent to meet service users’ needs. EVIDENCE: The home was adequately staffed during the inspection visit with carers and registered nurses supported by an activities coordinator, a cook, a cleaner and a laundry worker. The registered manger described proposals for new staffing arrangments for the home based on the increased numbers and needs of the service users. At the time of the inspection there were no staff in the home with training to NVQ level two or above. Two staff are currently working towards this qualification and the registered manager and another member of staff are currently working towards becoming NVQ assessors. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 18 The records for the two recently recruited members of staff were examined. All the required information and documentation had been obtained with all required checks made with any risk assessments completed where necessary. Staff are provided with induction and foundation training in line with national specifications; this was outlined on a training report where a number of recently recruited staff had received induction training. The Elms DS0000062586.V313559.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is well managed with quality assurance systems and staff supervision in operation to ensure that the home is run in the interests of service users. The home has arrangements for ensuring that service users’ financial interests are safeguarded. Safe working practices ensure service users safety although some improvements are needed with the storage of cleaning materials. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered manager is a first level registered mental nurse and is about to complete the registered managers award at NVQ level 4. She also has a teaching qualification relevant to nursing and has recently completed training in abuse and challenging behaviour, verification of death and first aid. She has previous experience as a deputy manager at another care home for four years. The home conducts an annual quality assurance survey and this had been completed at the time of the inspection visit. Comments from the survey are collated and any requiring action are followed up by the registered manager or the director of care and detailed in an action plan, which was seen during the inspection visit. In addition monthly unannounced visits are made to the home by a representative of the provider and reports are produced which are sent to the Commission. The home provides secure facilities for storing service users’ money and valuables both centrally and with locked drawers in bedrooms. Records associated with the storage of money for one of the service users selected for inspection was looked at and found to be in good order. The registered manager is currently pursuing the issue of the lack of keys for service users lockable storage facilities in their rooms. Staff supervision records were examined; given the present rate of sessions the home would be on course to achieve six supervision sessions for each member of staff within a year. The home has ensured the servicing and maintenance of electrical and heating systems and appliances as well as hoists and the lift. Regular checks are made on hot water temperatures and recorded along with a number of other safety checks. The most recent fire drill held in the home was in September 2006, a record of this had been made with comments added. Work was carried out in 2005 regarding the risk of Legionella in the home. The home keeps a record of accidents and incidents and monitors these with an audit. Staff have received health and safety awareness training, infection control training and moving and handling training was planned for all staff for December 2006. The storage of cleaning materials was examined and it was found that some materials had been decanted in to inadequately labelled containers which is not in line with the Control of Substances Hazardous to Health (COSHH) Regulations. This was discussed with the registered manager. The Elms DS0000062586.V313559.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 (4) (c) Requirement The registered person must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated (This refers to cleaning materials that must be stored in adequately labelled containers in line with the Control of Substances Hazardous to Health Regulations (COSHH) 1988). Timescale for action 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP15 OP26 Good Practice Recommendations Medication storage temperatures should be monitored in all storage areas if there is a delay in centralising the medication storage. It is recommended that there is more detail in the record of alternative meals provided for service users. It is recommended that a more permanent solution is found to covering the gap in the laundry flooring. DS0000062586.V313559.R01.S.doc Version 5.2 Page 23 The Elms 4. 5. OP28 OP36 More care staff should be trained to NVQ level two. Continue with the present rate of staff supervision sessions to achieve six sessions per year for care staff. The Elms DS0000062586.V313559.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 The Elms DS0000062586.V313559.R01.S.doc Version 5.2 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. 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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