Care Home: Westwood

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What the care home does well Service users are able to say how they want their care to be provided, and about the way they want to live their lives. They are able to speak directly to the manager and the staff. Service users are give a healthy and balanced diet, and they have choice over the food they are given. They said they were very satisfied with the food they received. Service users also indicated they were satisfied with how their emotional , physical and health care needs are met. Service users are supported to have an active and varied social life with many opportunities to be included in the local community. Opportunities exist for them to further their educational and occupational activities. Staff are enthusiastic and are safely recruited for the jobs they do. Service suers made very positive comments regarding staff and made comments such as "they are all lovely", "they listen to me all the time and help me" The home is well managed and organised, and the staff know the service users well. Service users visit the home before they make decisions about living at the service and are given information, which helps them, makes choices about living there. Service users said that they enjoy staying at the home. What has improved since the last inspection? Service users now interview prospective new staff and will be involved in staff inductions. This means that service users have more choice regarding who looks after them. More of the polices including the service user guide, have been produced in pictorial format which gives service users more information in a format that they can better understand. Staff heath declarations are now contained within staff recruitment files. This means that the organisation can be aware of any issues staff may have and the support they may require to carry out their roles, while still remaining safe. Care plans now contain information regarding service users wishes if they become very unwell or when they die, this means that service users choices and wishes are carried out even when they are not able to inform people of these. A full decoration programme is underway and the lounge, dining room and some bedrooms have all been decorated. What the care home could do better: The manager is applying for more funding so that those service users who require one to one support have more opportunity to access the community and participate in activities. Staff who are employed by the organisation and do occasional work at the service must have all of their staff details available for authorised people at all times. This means that service users can be confident that people who have been safely recruited are caring for them. CARE HOME ADULTS 18-65 Westwood 55 St Helen`s Park Road Hastings East Sussex TN34 2JJ Lead Inspector Kathryn Emmons Unannounced Inspection 4th March 2008 2:30 Westwood DS0000021283.V359537.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 Westwood DS0000021283.V359537.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. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westwood Address 55 St Helen`s Park Road Hastings East Sussex TN34 2JJ 01424 428805 01424 422082 sue.palmer8@btinternet.com 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) Hastings & Bexhill Mencap Society Susan Elizabeth Palmer Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of residents to be accommodated is nine (9) The people accommodated will be between the age of eighteen (18) and sixty-five (65) years on admission That the home can continue to provide care and accommodation to a service user who was admitted over the age of sixty-five years on admission. Date of last inspection Brief Description of the Service: Westwood is a large two-storey detached property situated in a residential area of Hastings. Shops and transport links are close by. The home is registered to provide care and accommodation to nine people with Learning Disabilities. All service users have single bedrooms. There are currently no vacancies. The registered providers are Hastings & Bexhill Mencap Society. The weekly fees range from £330 to £480. Westwood DS0000021283.V359537.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 2 star. This means the people who use this service experience good quality outcomes. A visit to the service took place on 4 March 2008. This visit was unannounced and took place over 3 hours. The registered manager was present during the visit. Care received by two service users was looked at in detail. This is a method called case tracking. This included looking at their personal records, a range of general home records and staff detail records. Staff were observered providing care and were given the opportunity to speak with us. We received a completed self-audit document completed by the registered manager, to provide information before we did a site visit. We also looked at how the provider makes information about their service, including CSCI reports available to prospective service users. We sent out pre inspection questionnaires prior to the inspection and all comments received back were complimentary. During the visit we spoke with the manager, a member of staff and six residents. What the service does well: Service users are able to say how they want their care to be provided, and about the way they want to live their lives. They are able to speak directly to the manager and the staff. Service users are give a healthy and balanced diet, and they have choice over the food they are given. They said they were very satisfied with the food they received. Service users also indicated they were satisfied with how their emotional , physical and health care needs are met. Service users are supported to have an active and varied social life with many opportunities to be included in the local community. Opportunities exist for them to further their educational and occupational activities. Staff are enthusiastic and are safely recruited for the jobs they do. Service suers made very positive comments regarding staff and made comments such as “they are all lovely”, “they listen to me all the time and help me” The home is well managed and organised, and the staff know the service users well. Service users visit the home before they make decisions about living at the service and are given information, which helps them, makes choices about living there. Service users said that they enjoy staying at the home. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westwood DS0000021283.V359537.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 Westwood DS0000021283.V359537.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 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can be confident that their assessed needs can be met by the service. Contracts are in placed so residents can be clear on what service they can expect. Information about the service is provided in an easy read format. EVIDENCE: We could see from looking at care files that service users had contracts in place. We asked a couple of service users if they had been given information before they came to live at the home. Many of the them couldn’t remember but a new service user said they had been given information. The service provides 2 documents called a service user guide and a statement of purpose both of these provide information about the service. There are photographs and symbols so that service users can understand the information easily. A service user spoke about how they came to live at the service and said “I was happy right then when I was here for tea”. The manager said the organisation has an admission policy in place which includes doing a full assessment of the prospective service user, assessing if they would fit in with the other service users already living at the home and if their needs could be met. The new service user said” I like it here and I am getting my bedroom Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 9 painted”. The admission process consists of visits for meals and then an overnight stay followed by a trial period before a formal place is offered at the service. Westwood DS0000021283.V359537.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written records including risk assessments provide service users with confidence that their needs are known and they can be kept safe. Regular reviews of needs provide staff with detailed information to provide the correct level of support. EVIDENCE: We saw care files for two service users. Both of these contained written assessments, care plans and risk assessments. It was clear what the service users needs were and how these were going to be met. We could see from reading records that these were written in at least twice a day and the location of care plans meant that staff had access to them at all times. This enables staff to be kept up to date on the service users welfare. Service users we spoke with said “Sue (manager)and everyone knows how to help me” and “I have help when I cook in the kitchen”. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 11 There was evidence that reviews had taken place for one of the service users case tracked and there were reports in place from relevant people such as the community learning disability team. Information was in comprehensive details so that all needs of the service users were known. We could see that residents had been involved in their care plan and that they were also involved in reviews. Risk assessments were in place for activities ranging from assisting in the kitchen, showering, road safety, to accessing the community and using taxis. We also saw risk assessments for service users having their own front door keys. Residents have clear ownership of the home and on a couple of occasions were seen answering the door to other service users who were returning from day services. Lifestyle support plans included hopes and dreams for the future and what activities the service users participated in. All service users had a designated key worker and the manager told us that this system was fairly new but was working well. Westwood DS0000021283.V359537.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): 12,13,15,16, and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a varied and balanced diet and are able to have their choices catered for. Service users are able to participate in community activities. Service users right are upheld. EVIDENCE: We spoke with five service users, of which three told us about how they spend their days. We were told that there were opportunities to attend day services and go out to the local shops, have coffee out and go to the cinema and swimming. There are also activities in the service during the evening however many service users prefer to watch television and spend time in their rooms. The pre inspection information we received gave a list of all the activities service users had been able to participate in, these included discos, attending the organisations day centre and art group, trips out in the minibus and gym and local pub visits. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 13 Discussion with service users and the manager evidenced that service users were able to be as independent as possible and participate in as much community inclusion as was possible as long as the service users were kept safe and it the service users choice. During the visit we saw service users were able to spend their time how they chose. This included doing their laundry assisting with making the evening meal and watching television and doing art and craft work. Service users told us “sometimes I go to the shops and Sue takes us out in the minibus”. Service user told us that they could have friends and family visit them whenever they wanted. We also saw in service users records that they were able to stay with relatives when they wanted to and the service supports them to do this. We saw from service users records that some had signed up to a heath plan which included a healthy eating plan. The food was discussed with a couple of the service users who all said they had choice and enjoyed being involved in preparing the meals. One service user had a dietary requirement that all food was soft and easy to digest. This need was being met. Westwood DS0000021283.V359537.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 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are met and risk assessments are in place, and identify risks and how these will be minimized. Medication arrangements are good. EVIDENCE: We looked at the medication arrangements for the service users. Staff who give out medication have been trained to do this and understood the importance of giving the right medication at the right time. We saw two staff administer medication and they carried out this procedure correctly by administering the medication and then signing the medication record to show this task had been completed. There is a medication policy in place. Medication records we saw had been signed and completed correctly. Homely remedies had been agreed by the GP and signed consent was on the file. All medication administration sheets had the service users photograph so staff could be clear who they were giving medication to. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 15 Service users told us that they were satisfied with the care they received and that they were able to choose how they were given assistance. Examples given were “I am not rushed, with anything” and “I get my hair cut how I want it to be and the staff help me get my nails done” Service user records showed that there was good contact with all health care professionals including the local GP. Since the last inspection work has been carried out to record in service users files their choices regarding the treatment and care they would like if they become unwell or die. This information was obtained in a sensitive manner. Westwood DS0000021283.V359537.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident their concerns will be listened to and acted upon. Staff are trained in safeguarding adults procedures and service users are protected from harm. EVIDENCE: We spoke with three service users about what they would do if they had any worries or concerns. All of the service users we spoke with said that they were certain if they had any worries they would speak to the manager or any other staff who were on duty at the time. Another service user said they could speak to someone at the day centre they went to. We saw from training records and from speaking with the manager that staff had received training in safe guarding adult’s procedures. We also saw the staff training plan for the year and saw that training had been planned for further dates. One complaint had been logged since the last inspection and this was a complaint from one service user about another service user swearing. The manager had investigated this appropriately and followed the organisations complaints procedure. The manager said they were waiting for funding to make a video of the complaints procure so that more service users had easier access to the complaint procedure. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 17 One incident occurred which had been investigated as a safeguarding adults issue and had been jointly investigated by the organisation and the local social services department. The manager had dealt with this issue appropriately. The manager told us that new staff had criminal record checks in place before they were offered a position within the service. Protection of vulnerable adults (POVA) checks were also carried out and a record was in place to show these had been obtained. Westwood DS0000021283.V359537.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 ,25,27and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and tidy and provides service users with comfortable, safe and clean surroundings, which they are able to personalise. EVIDENCE: Since the last inspection of the service work has been carried out to upgrade the home. Redecoration of the lounge, dining room and several bedrooms has taken place. New flooring for several areas was on order and the heating system was due to be upgraded. Two service users showed us their bedrooms and these had all been personalised. One service user told us they had been able to choose the colour of their bedroom and was waiting for it to be painted. There are 7 rooms with sink only, another with a toilet and sink and one with an ensuite shower room. There are 3 additional toilets and an additional shower room and bathroom. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 19 The laundry has been moved to a building next to the main house and service users were supported to use this with staff support when needed. Service users were able to watch television in one of the lounges and play music and do art and craft work in the smaller lounge. There was sufficient seating in the lounges and dining area and all furniture was in a good state of repair. The home was clean and smelt fresh. There is a photo board by the main door with photographs of all staff and service users. This is used to show service users who is working and who is at home. Westwood DS0000021283.V359537.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 and 35. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are cared for by enthusiastic and trained staff. Recruitment records evidence that safely recruited staff work in the service. All recruitment records need to be available at all times to demonstrate that the right people care for residents. Supervision sessions enable development and training needs for staff to be identified. Service users involvement in interview selection and induction means they have control and choice over who cares for them. EVIDENCE: We were not able to look at recruitment records for one staff who was working during the inspection as they were employed by the organisation in a different service and worked at this service as bank staff. The manager confirmed that all records would be available for all bank staff in the future. We looked at records for two other staff. We could see that all staff had had the necessary recruitment checks undertaken including a (CRB) Criminal records Bureau check and written references. Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 21 The manager told us that interviews had been held and service users had been involved in the interview process. One of the service users rang the appointed person and told them they had got the job. The manager is working to provide service users with opportunities to be involved in new employees induction. A training plan was in place for all staff and we saw that courses had taken place and staff were attending equality and diversity training and Mental Capacity Act training in the near future. An induction programme is in place and all staff are enrolled on a nationally recognised induction course. This enables new staff to be aware of the polices and procedures of the service and how to care appropriately and safely for the service users. We saw from recruitment records that staff had a contract of employment and a job description. This enables them to be clear of their job role and what is expected of them. There are 2 staff on duty during daytime hours. With one member of staff working a sleeping night duty. The manager is working towards getting more one to one funding so more opportunities can be available for those service users requiring more support to be able to go out into the community, The residents who spoke with us made very positive comments about staff such as “Sue is lovely, they all are”, “they help me and I like them all”.” I like it here, I get on with most of them (service users) but all the carers are good”, and “They are all lovely and listen to me”. We could see from minutes produced that staff meetings take place. The manager aims to hold these every couple of months. We could see from staff files and through discussion with the manager that staff receive supervision sessions and these took place every two months. Westwood DS0000021283.V359537.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): 37,39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service is well run by a competent and trained manager. Service users are able to express their opinions and are encouraged to have ownership of the service. Checking of equipment and servicing of house systems keep service users safe. EVIDENCE: The services registered manager is Sue Palmer. The manager has been working at the service for three years, is in possession of the Registered Managers award and has many years experience of working with service users who have a learning disability. Through discussion with service users and the manager it was evidenced that the manager is promoting the service users Westwood DS0000021283.V359537.R01.S.doc Version 5.2 Page 23 rights and encouraging them to have more control over how the service is run. The manager works full time and has fourteen hours a week dedicated time to do managerial work such as updating records, undertaking assessments and dealing with staff issues. The service has a quality assurance programme in place, which is operated by the manager, this involves sending surveys to the daycentre the service users attend, relatives and service users. The findings are then put into a pictorial format and a report is produced for the service users. This is also given to the organisation who use the report to work with the manager to produce the service business plan. The organisation do monthly visits to the service and produce a report on the conduct of the home. These are required by us and are stored in the home. We are always told if an incident happens in the service, which affects the service users. We could see from pre inspection information and from a sample of records that we saw in the service that the manager ensures that service users and staff are kept safe in the service. Examples of this are fire safety checks and servicing of electrical equipment and the heating system. Westwood DS0000021283.V359537.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 3 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 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 4 x 3 x x 3 x Westwood DS0000021283.V359537.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 YA34 Good Practice Recommendations Recruitment records need to be in place for bank staff. Westwood DS0000021283.V359537.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 Westwood DS0000021283.V359537.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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