Care Home: Sheringham House

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What the care home does well The service provides a safe and comfortable home for individuals with complex needs that require management by an experienced and well-trained staff group. The strategies and positive interventions implemented by the service are judged to provide excellent outcomes for residents. Resident`s needs are thoroughly assessed, monitored and reviewed and there are appropriate risk strategies in place. The organisation has an open and inclusive culture that values, promotes and celebrates equality and diversity. An experienced and qualified manager provides excellent leadership and direction to a committed staff team. Other professionals see the manager as an imaginative and effective leader who consistently provides high quality outcomes. What has improved since the last inspection? Since the last inspection the home has made progress in reviewing and modifying the Statement of Purpose and Service user guides. There has been a significant reduction in behavioural incidents and improved access to the community as a result of positive interventions. There has been a hoist installation and handrails to facilitate independence around personal care.There has been an increase in the numbers of staff attaining an NVQ qualification. What the care home could do better: There are no requirements resulting from this inspection. It is recommended that medication administration records are better secured against loss or disarray. CARE HOME ADULTS 18-65 Sheringham House 54 Old Road East Gravesend Kent DA12 1NR Lead Inspector Paul Stibbons Unannounced Inspection 9th July 2008 12:00 Sheringham House DS0000067299.V367683.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 Sheringham House DS0000067299.V367683.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. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sheringham House Address 54 Old Road East Gravesend Kent DA12 1NR 01474 329807 01474 328285 Sheringham.house@achuk.com www.achuk.com Aitch Care Homes (London) Ltd 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) Mr Ian John Pitman Care Home 10 Category(ies) of Learning disability (0) registration, with number of places Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary needs admission to the home are within the following category: 2. Learning disability - LD The maximum number of service users who can be accommodated is: 10 30th August 2007 Date of last inspection Brief Description of the Service: Sheringham House provides a service for up to ten adults with a learning disability. The home has an organisational structure, which includes a manager and support workers, operating a roster, which gives 24-hour cover. There are no designated staff for catering or domestic duties. All residents are accommodated in single rooms. All contain en-suite toilet facilities; nine out of ten rooms provide en-suite bathing or shower facilities. The accommodation is arranged over two floors. There is no passenger lift. Good communal space is provided with a large garden and additional sensory building. The care providers are AITCH Care Homes (London) Limited, who have been operating since November 2001. The home is located in Gravesend within easy reach of the usual town facilities and public transport. The current core fee for the home is £1285.00 per week. Any additional charges are agreed individually with local authorities for those residents who require more support than that allowed for in the core fee. Full information about the fees payable, the service provided, the home’s Statement of Purpose and the latest inspection report by the CSCI are available from the manager. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced key inspection site visit was conducted over a period of 5 hours. The manager and deputy manager were present along with some of the residents. The annual quality assurance assessment (AQAA) had been completed and returned to the CSCI prior to this visit. A tour of the building was carried out and a variety of records and documents were examined. Discussions took place with management, staff and residents that were able to. What the service does well: What has improved since the last inspection? Since the last inspection the home has made progress in reviewing and modifying the Statement of Purpose and Service user guides. There has been a significant reduction in behavioural incidents and improved access to the community as a result of positive interventions. There has been a hoist installation and handrails to facilitate independence around personal care. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 6 There has been an increase in the numbers of staff attaining an NVQ qualification. 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 summary of this inspection report can be made available in other formats on request. Sheringham House DS0000067299.V367683.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 Sheringham House DS0000067299.V367683.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their representatives have sufficient information provided to make an informed decision as to whether this home will meet their needs. Prospective service users have their needs properly assessed as part of the admission and transition process. EVIDENCE: The home understands the importance of having sufficient information when choosing a care home. It has developed clear information to help them understand what specialist services the home can provide. The home provides a statement of purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service user’s guide. All residents are given a copy of the guide. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 9 When required the service can provide a copy of the statement of purpose and guide in a format which will attempt to meet the capacity of the resident. The service recognises the diverse communication needs of residents at the home and is currently working on differing formats to meet those needs. Admissions are not made to the home until a full needs assessment has been undertaken. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and a copy of the care plan. Prospective residents are invited to visit the home before moving in and are offered a three months trial period before a placement is confirmed. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are supported in making choices and decisions about their lives and their changing needs are reflected in individual care plans and risk assessments. People living in the home are supported in taking risks as part of an independent lifestyle and their right to confidentiality is upheld. EVIDENCE: Each resident has an individual plan of care. The individual plan of care is person-centred, and covers all aspects of the resident’s health, personal and social care needs. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 11 The service records the preferred communication style of individuals, and uses proven methods that enable the person to lead a full life that promotes independence and choice. These include communication aides such as makaton, photographs and symbols. An example was given to the inspector, where staff members listened to and noted the vocal sounds attached to an activity of one particular resident, this has led to improved communication and outcomes for the resident. The care plan is a working document with evidence of having been reviewed regularly. Reviews focus on asking what has worked for the individual, where there has been progress, achievements, concerns and identifies action points. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Confidential information in the home is securely stored with access restricted only to authorised personnel. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home have opportunities for personal development and engage in appropriate leisure activities both within the home and the local community. People living in the home receive a varied and healthy diet that is of their choosing. EVIDENCE: The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. The manager gave the inspector several examples of Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 13 where positive life experiences are promoted through the strategies and interventions employed by the home. For example, one particular resident with an eating disorder is now able to request food in a manner that promotes respect for him and re-inforces positive behaviour and outcomes for him. Another resident, where specific mobility issues restricted access to the community, was addressed by acquiring a different vehicle more suitable to his needs. The staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. Evidence was offered where residents in the past were reluctant to leave the home for any appreciable length of time are now going for short breaks and individual days out. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. Residents can access and enjoy the opportunities available in their local community, such as shopping, cinema, swimming, bowling, hydrotherapy, the local pub, and local leisure facilities. The programmes of activities offered are individualised to the needs of residents and are reviewed six monthly to ascertain whether any change to activities is required. Through the sustained interventions of the staff team there has been a significant reduction in incidents and more residents are able to access the community and experience positive life experiences. Where appropriate, residents are involved in the domestic routines of the home such as assisting with the washing or food preparation. Residents enjoy a varied and healthy diet and they are supported in choosing meals through the use of pictures and knowledge of their individual likes and dislikes. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from having their physical and emotional healthcare needs addressed by input from multi-disciplinary healthcare professionals. People living in the home are protected by the homes policies and procedures for managing medication. EVIDENCE: People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. People are supported and helped to be independent and can take responsibility for their own personal care needs. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 15 Residents have access to healthcare and remedial services. Staff members make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. Several examples of excellent practice were brought to the attention of the inspector where the staff team have identified health care problems and sought the advice of other healthcare professionals and supported residents in achieving significant improvements in their quality of life. Residents have the aids and equipment they need and these are well maintained to support them and staff in daily living. A new chair for one resident now enables him to explore his environment and make choices. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. It is a recommendation of this report that medication records are kept in poly pockets to be better secured against loss or disarray. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to express their views and a complaints procedure is in place to address their concerns. People living in the home are protected from abuse and their rights upheld. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents spoken with say that they are happy with the service provided, feel safe and well supported by the staff. The service has a complaints procedure that is clearly written and easy to understand. It is available in a number of formats including pictorial to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Discussions with staff working at Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 17 the service demonstrated that they know when incidents need external input and who to refer the incident to. There is a clear system for staff to report concerns about colleagues and managers. Staff that ‘blow the whistle’ on bad practice are supported by the service. Training of staff in safeguarding is regularly arranged by the Home. Other training around dealing with physical and verbal aggression is also made available to staff as needed. Staff members understand what restraint is and alternatives to its use in any form are always looked for. Staff members were observed during this visit to deal with incidents appropriately. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home enjoy a homely, safe and comfortable environment with adequate personal and communal space to meet their needs. People living in the home benefit from the provision of specialist equipment that they require to maximise their independence. EVIDENCE: The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment such as hoists, handrails and specialist chairs to meet their needs. The home is a very pleasant, safe place to live with Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 19 adequate personal and communal space to meet the needs of people who live there. Most bedrooms have en-suite facilities. Residents are encouraged to personalise their bedrooms and one resident spoken with confirmed they were happy with their room. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with a spacious lounge and a smaller room that allows opportunities to meet relatives and friends in private. There are WC facilities that reasonably accessible to the communal areas and maintained to a good standard. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy in place and staff training is currently taking place. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents individual and joint needs are met by a competent and appropriately trained staff team who are supported and supervised. People living in the home are protected by robust recruitment policies and procedures. EVIDENCE: Staff members undertake external qualifications beyond the basic requirements such as NVQ awards and over 50 of the staff team already have attained the award with others working towards the qualification. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 21 Staff rotas viewed indicate that there are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. All staff attend relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff members spoken with confirm that the home was clear about what was involved at all stages and was robust in following its procedure. Staff meetings take place regularly. Supervision sessions are held every six to eight weeks and notes and action points are taken of meetings and sessions. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, 43 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a home that is run by a competent and qualified manager and where their best interests are safeguarded by the homes record keeping policies and procedures. The health, safety and welfare of people living in the home is promoted and protected and their views underpin all self-monitoring and development by the home. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager has the required qualifications and experience, is highly competent to run the home and meet its aims and objectives. The manager’s practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. Discussions with the manager demonstrated that they have a clear understanding of the key principles and focus of the service, based on organisational values and priorities and they work to continuously improve services. They provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, there has been a significant reduction in incidents in recent months. Discussions and observations throughout this inspection indicates that the manager manages his staff team in an open and inclusive way which impacts very positively on the outcomes for residents. The completed AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes the home have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. Staff members have all received training around adult protection issues and interventions. There is also evidence of strategic development and organisational monitoring by corporate providers. Records are of a good standard and are routinely completed. All relevant health and safety checks have been carried out. Quality assurance systems are in place that includes questionnaires for residents, staff and relatives. The manager has arranged for three families of residents to become involved in an independent audit of the service. The home has access to professional business and financial advice and has all the necessary insurance cover to enable it to fulfil any loss or legal liabilities. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 24 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 4 4 4 4 4 4 Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Medication administration records should be better secured against loss or disarray. Sheringham House DS0000067299.V367683.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sheringham House DS0000067299.V367683.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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