Inspection on 23/08/06 for Tudor Avenue, 3

This inspection was carried out on 23rd August 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tudor Avenue, 3 24/11/05

Tudor Avenue, 3 19/08/04

Tudor Avenue, 3 07/04/04

Tudor Avenue, 3 26/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Tudor Avenue, 3 3 Tudor Avenue Hampton Middlesex TW12 2ND Lead Inspector Simon Smith Unannounced Inspection 23rd August 2006 11:00 Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 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 Tudor Avenue, 3 DS0000017395.V311868.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 Adults 18-65. 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. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor Avenue, 3 Address 3 Tudor Avenue Hampton Middlesex TW12 2ND 020 8979 2696 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) London Borough of Richmond upon Thames Ann Elizabeth Bruce Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: 3 Tudor Avenue is home to a maximum of six adults with learning disabilities. The property is owned and maintained by the London & Quadrant Housing Association. The service is managed and staffed by the London Borough of Richmond upon Thames. Residents’ fees are calculated according to their individual needs. The home is situated in a pleasant residential area with good access to local shops and community facilities. The building occupies a corner plot offering gardens to the sides and rear. A good standard of decoration has been achieved throughout the home. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a wide range of sources when making judgements about the home. These included a visit to the home and discussion with residents, staff and the manager. Surveys were given to residents, relatives and staff. A sample of records was examined at the home, including staff and residents’ files. The inspector was made welcome during the visit and wishes to thank residents, staff and all those who gave their views about the home. The home met 20 of 26 National Minimum Standards assessed at this visit. Six Standards were almost met. Two Requirements made at the last inspection had not been met and are reinstated in this report. Three residents completed surveys with staff support and returned them to the CSCI. Three relatives and three members of staff also responded. All family members returning surveys said that staff understand residents’ needs and that they are satisfied with the care their relative receives. One relative said they were “very, very satisfied” with the care provided by the home and described some of the carers as “magnificent”. Another family member said that their relative “is happy and well looked after – thank you to the staff”. One relative said that they would like the home to maintain more regular contact with them. Staff said that they have enough training and support to do their jobs but felt that the shortage of permanent staff and high use of agency staff has had an effect on residents’ care. What the service does well: What has improved since the last inspection? Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 6 Circles of support meetings have been held for some residents. Staff have continued to develop day opportunities for residents outside the resource centre environment. The resource centre linkworker has organised a number of successful sessions. An additional permanent member of staff has been recruited subject to preemployment checks. 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. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Information about the home is available to residents. Residents’ needs and strengths are effectively identified. EVIDENCE: The home has produced a Statement of Purpose, which gives details of the services and facilities provided and the aims and objectives of the service. A Service User Guide is available to all residents. Residents’ needs were assessed at the time of their admission. The home is committed to developing individual plans that are person-centred and reflect the needs and aspirations of residents. The design and layout of the home meets the needs of those who live there. Adaptations and specialised equipment have been installed where necessary to support residents’ mobility. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. There is a commitment to person-centred planning. The home records residents’ needs and strengths and works with residents to identify goals that are important to them. Residents receive good support to make informed choices about their lives. There is a commitment to supporting residents in taking manageable risks. EVIDENCE: An individual care plan is in place for each resident, which aims to reflect the skills, strengths, needs and goals of residents. Care plans contained brief monthly updates on areas including health, day services, social activities and finance. Monthly reviews are also used to monitor progress towards individual goals. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 10 The home is committed to introducing person-centred planning and has begun to develop circles of support for residents. A member of staff spoken to during the inspection said that keyworkers are responsible for arranging circles of support meetings, which aimed to involve the resident and important people in their lives, such as family members, friends and relevant professionals. The member of staff reported that she had co-ordinated the first circle of support meeting for her key client and that this had yielded much information on which to base an individual plan. There is a plan to introduce a ‘Total Communication’ programme to the home, a scheme designed to improve communication opportunities for residents, although the manager reported that there has been a delay in implementing the programme. The delay has occurred as the success of the project is dependent on the staff team adopting a consistent approach in their work with residents and the speech and language therapist co-ordinating the scheme is unwilling to begin work until the staff team is settled and stable. The manager and staff demonstrated a good knowledge of residents’ individual needs and a commitment to supporting residents in making informed decisions about their lives. Observation during the inspection confirmed that residents are able to choose the way in which they spend their time at the home and residents’ programmes reflect individual needs and interests. Residents are supported to access advocacy services if they wish to do so. Discussion with staff demonstrated that there is a commitment to promoting the rights of residents to take manageable risks in their lives. Risk assessments have been developed for specific activities undertaken by residents. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents participate in activities appropriate to their needs and preferences. Residents are involved in their local community. Residents are supported to develop and maintain positive relationships. Residents’ rights and responsibilities are promoted. The home’s menu is varied and well balanced. EVIDENCE: There is evidence that residents are involved in their local community and take part in a range of day opportunities and leisure activities. All residents attend at least one holiday each year and visited Dorset in the week prior to inspection. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 12 All residents attend the Avenue Centre as part of their day opportunities programmes. The Centre has allocated a linkworker to the home and staff reported that a number of sessions organised by the linkworker, such as companion cycling, have proved successful. Staff are aware of the planned closure of the resource centre and are working with the linkworker to arrange day opportunities for residents outside the resource centre environment. Most residents have regular contact with family members and the home aims to support residents in developing friendships. Residents are also encouraged to celebrate birthdays and other events at the home. Residents are supported to access advocacy services if they wish and one resident has regular contact with an advocate. Two of the three family members returning surveys reported that the home helps their relative to maintain contact with them. One family said that since their relative’s keyworker had left, the frequency of contact made with them by their relative had diminished significantly. The home should take this comment on board and consider how best to support all residents in maintaining contact with their families. Interaction between staff and residents was positive during the inspection. Residents’ wishes and needs are clearly identified in their individual plans. Staff used appropriate forms of address when speaking to residents. Residents made clear choices about how they spent their time at the home during the inspection. The advertised menu indicated that the home provides a varied and wellbalanced diet. Staff said that residents are encouraged to contribute to menu planning and that alternatives to the planned menu are available where required. Snacks and drinks are available at any time. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents receive personal support in the way they prefer. Residents are supported to access community and specialist healthcare resources where necessary. The home works co-operatively with other professionals in delivering care. The administration of medication must improve. EVIDENCE: Staff on duty demonstrated a good knowledge of residents’ healthcare needs and care plans contained guidance for staff delivering care. Care plans also provided evidence that medical appointments are made if needed and that appropriate healthcare professionals are involved in residents’ care where necessary. All accidents/incidents and healthcare appointments are recorded. Staff advised that the home is working towards the development of Health Action Plans for residents, although the community nurse involved with the Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 14 project has advised staff that they must complete health checklists for residents prior to individual plans being drawn up. The home must ensure that this work is completed to enable the development of the Health Action Plans. There is an appropriate system for the storage and administration of medication. All medication coming into or leaving the home is recorded. There are clear protocols governing the administration of medication. Medication records for three residents were examined and it was noted that on one occasion a resident had not received their prescribed medication. See Requirement 1. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Appropriate procedures are in place for the management of complaints. Training must be provided for all staff in the recognition, prevention and reporting of abuse. EVIDENCE: The home has an appropriate Complaints procedure. There have been no complaints made about the home since the last inspection. The service works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’, which provides guidance for staff in the recognition and reporting of abuse. The London Borough of Richmond also has a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. Inspection of records and discussion during the visit indicated that training is needed for some staff in the Protection of Vulnerable Adults. See Requirement 2. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The communal rooms of the home are welcoming and homely. The home is clean and hygienic. Action is required in some areas to maintain the appearance of the home. Potentially harmful products must stored safely. EVIDENCE: The home is situated in a pleasant residential area and has good access to local community facilities, open spaces and public transport networks. The property occupies a corner plot and has gardens to the sides and rear. The communal rooms of the home were welcoming and homely and all areas of the property were clean and hygienic. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 17 The last inspection report highlighted the section of plasterwork adjacent to the front door as needing attention. This issue has yet to be addressed and the Requirement is reinstated. See Requirement 3. The last inspection report also made a Requirement that all substances potentially harmful to health (COSHH products) are stored appropriately within the home. This visit found that the cupboard containing COSHH products (sited in the laundry room) was open, providing easy access to the products inside. See Requirement 4. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. There has been high use of agency staff to supplement the permanent staff team, which has affected the service provided to residents at times. Staff are appointed following an appropriate recruitment and selection procedure. Records of staff training must improve. EVIDENCE: Three staff were on duty at the time of inspection, two of whom were members of the permanent team and one of whom was a member of agency staff. Whilst there were enough staff on duty to meet residents’ needs, the shortage of permanent staff has clearly been a cause for concern during the past year. All three staff returning surveys identified this issue as an area in which the home could improve. In some instances this has had an effect on the service provided to residents. For example, as highlighted in the ‘Individual Needs and Choices’ section of this report, the speech and language therapist has been unwilling to start a Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 19 programme designed to improve communication opportunities for residents due to the instability of staffing at the home. In order to provide the best level of service to residents, the home must continue to its efforts to recruit and retain staff, with support from the central functions of the Council where necessary. See Requirement 5. The manager reported that a full-time support worker had recently been appointed and was waiting for pre-employment checks. The manager advised that, once this post had been filled, the service will have 2.5 full-time equivalent vacancies. Records for two members of staff were examined. Both provided evidence of a robust recruitment procedure and confirmed that the home carries out appropriate pre-employment checks on staff, including Criminal Records Bureau disclosures. Staff spoken to during the inspection, and those returning surveys, reported that they are encouraged to attend training relevant to their roles. The member of agency staff on duty said that she had completed all areas of mandatory training through her agency. However records of training must improve, as they do not accurately reflect the training undertaken by staff. For example records failed to record any medication training for staff, although the manager reported that staff have attended recent training in this area. See Requirement 6. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home has an experienced manager who knows the service well. There is a commitment to effective quality monitoring and to running the home in residents’ best interests. The health and safety of residents is maintained, although water temperatures must be effectively regulated. EVIDENCE: The manager has a good deal of experience in her role and clearly knows the home and residents well. Surveys received from staff were generally positive regarding the management of the service and the support provided by the home manager. Staff on duty at the time of inspection also reported that the manager is approachable and supportive. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 21 Discussion with staff confirmed that there is commitments to running the home in the best interests of residents and to ensuring residents’ wishes are met wherever possible. The home aims to seek residents’ views through regular meetings, which are supported by staff. Residents are encouraged to involve themselves in the routines of the home and are consulted about decisions in the home that affect them. The service is regularly monitored by the Council’s Quality Assurance officer. These monitoring visits aim to ensure that the service reflects residents’ needs and wishes and seek to identify areas for improvement. Staff conduct a weekly health and safety check. The most recent check on file took place on 21 August 2006. Staff also record water temperatures in the home. The most recent test results on file (April 2006) recorded temperatures in two residents’ bedrooms that were too high for safe use. See Requirement 7. The home has an appropriate fire detection system. The fire alarm and emergency lighting systems were checked by an engineer in June 2006. The last fire drill took place in June 2006. The home has appropriate Employers’ Liability Insurance until March 2007. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13(2) Requirement The Registered Person must ensure that medication is accurately administered and recorded. The Registered Person must ensure that all staff receive training in the Protection of Vulnerable Adults. The Registered Person must repair the section of plasterwork adjacent to the front door. The Registered Person must ensure that all substances potentially harmful to health are stored appropriately within the home. The Registered Person must ensure that the use of agency and temporary staff does not adversely affect the service provided to residents. The Registered Person must improve records of staff training. The Registered Person must ensure that hot water is delivered at safe temperatures. Timescale for action 21/09/06 2 YA23 13(6) 30/11/06 3 YA24 23(2) 30/10/06 4 YA24 12(1)13(4) 21/09/06 5 YA33 18(1) 30/10/06 6 7 YA35 YA42 18(1) 13(4)23(4) 30/10/06 30/09/06 Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA19 YA15 Good Practice Recommendations Complete health checklists for residents to support the development of individual Health Action Plans. Consider how best to support all residents in maintaining contact with their families. Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Tudor Avenue, 3 DS0000017395.V311868.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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