Inspection on 03/05/07 for West Lodge Care Home

This inspection was carried out on 3rd May 2007.

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

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

Other inspections for this house

West Lodge Care Home 30/03/09

West Lodge Care Home 28/11/08

West Lodge Care Home 19/04/06

West Lodge Care Home 09/11/05

West Lodge Care Home 13/06/05

West Lodge Care Home 25/01/05

West Lodge Care Home 24/08/04

West Lodge Care Home 12/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE West Lodge Care Home 238 Hucknall Road Sherwood Nottingham NG5 1FB Lead Inspector Steve Keeling Unannounced Inspection 3rd May 2007 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 West Lodge Care Home DS0000026478.V339394.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. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Lodge Care Home Address 238 Hucknall Road Sherwood Nottingham NG5 1FB 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) 0115 960 6075 0115 960 6075 Ms Razma Vanessa Alishan Ms Razma Vanessa Alishan Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (4) of places West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total number of beds a maximum of 4 bed maybe used for the category PD 19th April 2006 Date of last inspection Brief Description of the Service: West Lodge Care Home was established in 1987 and provides nursing and personal care for 27 residents. Within this number, the registration allows admission for up to 4 people who have a Physical Disability. Located on a main road in Sherwood, it is on a main bus route into Nottingham city centre. The home consists of a large converted house, with a purpose built conservatory. There are 6 double bedrooms and 13 single rooms 4 of which have en-suite facilities. There is ramped access to the building and a passenger lift serves all three floors. The homes grounds are mainly to the front of the building and are well maintained although there is open access to the road. There is car parking space at the front of the home. The provider makes the statement of purpose and service users guide available to all residents or their representatives. Which provides comprehensive information relating to the facilities at the home. A copy of the last report from Commission of Social Care Inspection (CSCI) is also available in the foyer of the home. The minimum fees are currently £262 and the maximum are £410 per week. There is an extra charge newspapers, hairdressing and toiletries. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit on the 3rd and 4th of May 2007. The main method of inspection used was called ‘case tracking’ which involved selecting two residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager, two members of staff and two relatives were spoken to as part of this inspection. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this inspection, which includes information received from residents in response to questionnaires, together with information from the registered provider within a pre-inspection questionnaire received in April 2007. As part of the inspection process the conditions of registration were reviewed with manager and the information on the registration certificate was correct. What the service does well: Potential residents undergo an effective pre-admittance needs assessment and residents are provided with the opportunity to visit the home prior to moving in. Residents are afforded appropriate levels of privacy and their dignity. Residents have opportunities to access the local community and to maintain their links with family and friends. Routines are flexible and residents are given West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 6 choices in their lifestyle and social activities. Residents also benefit from a varied menu, which includes meeting individual’s cultural needs. Resident’s safety is promoted as staff have received training in relation to the Safeguarding Adults. Resident’s benefit from a safe, well-maintained environment, which is comfortable, clean and fresh. Resident’s needs are met by the number of staff employed at the home and staff have received appropriate training to meet the needs of the residents. Residents’ finances are securely held and properly recorded to make sure their interests are protected Routine maintenance is effective in promoting the residents safety. What has improved since the last inspection? What they could do better: Care planning documentation could be further developed to provide sufficient details to inform staff of the care management of residents. A complaints procedure could be distributed to all residents and their representatives. Effective quality auditing procedures could be performed to reflect that the quality of care provided at the home is reviewed at appropriate intervals and systems are in place for improving service provision. Regulation 26 visits could be performed on a monthly basis and a copy of the reports could be made available to CSCI and the manager at the home. Please contact the provider for advice of actions taken in response to this West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 8 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 West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Standard 3 was inspected on this occasion. This judgement has been made using available evidence including a visit to this service. People have a assessments performed prior to moving into the home, to make sure their needs can be met. Residents are provided with the opportunity to visit the home if they wish. Intermediate care is not provided at West Lodge Care Home. EVIDENCE: The manager stated that she performs pre admittance assessments on all potential residents to ensure that their health and social needs can be identified and met. Records show that the case tracked residents had undergone needs assessment prior to gaining residency at the home and evidenced that professional assessments are also utilised when available, which includes West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 10 assessments from social services departments and hospital discharge documentation. A resident spoken with confirmed that he had undergone a pre-admittance assessment and had the opportunity to visit the home prior to gaining residency so that he could determined the suitability of the service in meeting his needs. The home does not provide an intermediate care service. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Adequate. Standard 7, 8, 9 and 10 was inspected on this occasion. This judgement has been made using available evidence including a visit to this service. Residents health care needs are not sufficiently recorded which could lead to residents needs not being fully met. Their medication is now well managed and they are afforded appropriate levels of privacy and their dignity. EVIDENCE: Some care plans lacked sufficient detail to effectively manage the residents identified needs. A care plan relating to the management of a residents angina only contained “make sure GTN spray in available at all times”, furthermore a care plan relating to a residents susceptibility to epileptic seizures lacked sufficient detail. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 12 The care planning records are very bulky and disorganised and contained irrelevant information which will impede the care staffs access to information to promote the health and wellbeing of residents. A resident said that he had seen his care plans and verbally agreed to the content of the plans. There was no evidence of the resident’s signature within the care planning documentation to confirm this. Relatives visiting the home said that they did not know anything about care plans and had not seen them. Medicines, which need cold storage, were stored within a drug fridge but staff did not ensure that the temperature was maintained between 2-8 digress centigrade. The temperature in the medication room significantly exceeded 25 degrees. The medication room door was propped open with a chair and resident’s drugs were easily assessable within the medication room. Staff were observed to maintain the residents privacy and dignity and were observed to be polite and helpful at all times. A case tracked resident stated that he felt very safe at the home and that staff promote his independence and privacy at all times, whilst respecting his decisions and choices. Visitors to the home also believed that residents were well cared for and that staff are always respectful, friendly and caring. Given that the manager addressed the concerns in relation to medication management on the day of the visit, we have been proportional in our judgement and assessed the health and personal outcome group as adequate. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Standard 12, 13, 14, 15 was inspected on this occasion. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to access the local community and to maintain their links with family and friends. Routines are flexible and residents are given choices in relation to their lifestyle and social activities. Residents also benefit from a varied menu at the home. EVIDENCE: The manager and a member of staff stated that residents are provided with a wide range of social activities at the home, which includes board games, arts and crafts, ball games, bingo, movement to music, keep fit and guest entertainers on a monthly basis. A resident spoken with confirmed that social activities take place in the home and stated that he was satisfied with them. The resident also confirmed that he accesses the wider community when his relatives take him out on day trips. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 14 The relatives, carers and advocates survey asked, “Does the care home help your friend or relative keep in touch with you”, 100 of the responses received by CSCI stated, “yes”. The manager and a member of staff stated that an “open door” policy is promoted at the home. A resident and two visitors to the home confirmed the open door policy and stated that residents family and friends can visit the home whenever they wish and they are always made very welcome by all the staff. A resident confirmed that he is always asked his preferences in relation to meal provision. He stated that he was very satisfied with the catering facilities as a wide selection of interesting, varied meals is always made available and that meals portions are very good. The resident also confirmed that snacks and drinks are available at all times. On the day of the inspection the lunchtime meal consisted of corned beef hash and vegetables. An alternative menu was available which catered for the high percentage of residents from the Afro-Caribbean community, which consisted of green bananas with yellow yam dumplings. At lunchtime, staff interacted well with residents and were sensitive to the needs of residents who required assistance to eat. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Standards 16 and 18 were inspected on this occasion. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are not fully aware of the complaints procedure at the home, which could compromise the resident’s safety. Staff have received training in relation to the safeguarding adults. EVIDENCE: Residents spoken with stated that they felt very safe, well looked after and could not identify any areas of concern whatsoever in relation to the conduct of the staff at the home. A staff member spoken with demonstrated appropriate knowledge in relation to the management of complaints. The member of staff stated that should she receive a complaint or concern she would document the issues identified and liaise with senior staff or the manager at the home to ensure the complaint was addressed effectively. CSCI has not received any complaints relating to the home since the last unannounced visit and the manager was not investigating and concerns or complaints. Records show that the manager had recieved four minor complaints since the last inspection, all were documented with actions and outcomes recorded. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 16 The relatives, carers and advocates survey asked, “Do you know how to make a complaint about the care provided at the home?” only 20 of the responses received by CSCI stated, “yes”. The residents survey asked, “Do you know how to make a complaint”, 70 of the responses received by CSCI stated, “yes” with 30 stating no. Records show that the complaints procedure is included in the service users guide. Residents and relatives were not fully aware of the complaints procedure but those spoken with were confident that the manager would deal with any complaints. Training records showed that staff have received training in relation to the Safeguarding Adults and staff spoken with were able to confirm this. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Standards 19 and 26 were inspected on this occasion. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a safe, well-maintained environment, which is comfortable, clean and fresh throughout. EVIDENCE: The residents survey asked, “is the home fresh and clean”, 70 of the responses received by CSCI stated, “yes” with 20 stating usually and 10 stating sometimes. Comments made by residents within the survey included “always warm comfortable and airy” and “the home is very clean”. A resident and two visitors expressed satisfaction with the standard of cleanliness throughout the home, which included the resident’s bedrooms. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 18 Resident’s bedrooms are homely, safe and personalised with personal possessions such as family pictures, small items of furniture, a television, radio and ornaments. Window restrictors and radiator guards were evident to protect the residents, together with appropriately placed nurse call buttons to ensure staff can attend to the residents needs effectively over the 24-hour period. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Adequate. Standards 27, 28, 29 and 30 were inspected on this occasion. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the number of staff employed at the home and staff have received appropriate training. Recruitment practices are effective in ensuring the safety of residents. EVIDENCE: The relatives cares and advocates survey asked, “do the care staff have the right skills and experience to look after people properly”, 70 of the responses received by CSCI stated, “yes” with 30 stating usually. A resident stated that he felt very safe and well looked after. Visitors to the home stated, “staff appear to be well trained and very confident in performing their duties”. Records show that appropriate training opportunities are provided to staff in relation to the Safeguarding Adults, Moving and Handling, Infection Control, Food Hygiene, First Aid and Dementia Awareness. Staff files evidenced that some staff had commenced employment before satisfactory Protection of Vulnerable Adult (POVA) checks and Criminal Record Bureau (CRB) checks have been obtained. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 20 Although the required checks had been obtained approximately two months after employment had commenced. Two staff files failed to provide proof of identity. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is Adequate. Standard 31, 33, 35 and 38 were inspected on this occasion. This judgement has been made using available evidence including a visit to this service. Quality auditing systems are not in place to ensure the resident’s safety regarding medication management. Appropriate measures are in place to ensure that residents’ financial interests are safeguarded and routine maintenance is effective in promoting safety. EVIDENCE: Residents, visitors and staff expressed positive comments in relation to the manager’s ability. Visitors stated, “the manager is very approachable and addresses any concerns effectively”. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 22 Records show that care staff receive formal supervision sessions from the manager on a bi-monthly basis and the qualified nurses receive supervision on a six monthly basis. Staff confirmed that they feel supported by the manager and value the provision of supervision in identifying any issues of concern they might have in relation to the service provision at the home. An effective quality auditing system could not be evidenced on the day of the visit and the manager confirmed that she does not perform frequent qualitymonitoring audits in relation to the environment and care provision, which includes the management of care plans and medication management. Regulation 26 monitoring visit are not performed. The current procedures for dealing with residents personal finances does not adhere to Standard 35 of the Care Standards Act 2000 which could place the residents at risk of financial abuse. In determining that the service users are safe within the homes environment a range of Health and Safety records were provided by the manager in the preinspection questionnaire relating to gas safety certificate, fire safety drills, fire equipment checks, emergency lighting checks, hoist checks and Legionella prevention measures all were found to be satisfactory. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 23 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 2 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 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 2 x x 3 West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement Care planning documentation must be further developed to enable someone not familiar with the resident to deliver the appropriate care thus promoting the residents safety. 1. Care plans must be developed to provide sufficient information for staff on how to effectively support residents with their identified needs. To promote the safety of residents the complaints procedure must be made available to them and or their representatives.’ Effective quality auditing procedures must be performed to ensure that the quality of care provided to residents at the home is reviewed at appropriate intervals and systems are in place for improving service provision for the residents. To ensure service provision is effective in promoting the health and wellbeing of residents, Regulation 26 visit must be DS0000026478.V339394.R01.S.doc Timescale for action 31/07/07 2 OP16 22 31/07/07 3 OP31 24 31/07/07 4 OP33 26 31/07/07 West Lodge Care Home Version 5.2 Page 25 5 OP35 20 performed on a monthly basis and a copy of the Regulation 26 reports must be made available to CSCI and the manager at the home. To ensure that residents are 31/07/07 protected from financial abuse the money of individual residents personal allowances must not pooled. The finances of residents must be individuality maintained and appropriate records and receipts are kept. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations Irrelevant information within care plans must be removed to promote ease of access to information for staff. West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI West Lodge Care Home DS0000026478.V339394.R01.S.doc Version 5.2 Page 27 - 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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