General Information Please state the number of years you Please state the number of years you If you have purchased an existing care home within the last 12
Please Select
N/A
No
Yes
If not, please provide details: Proposers History Have you or any other partner or director, Have you or any other partner or director, Have you or any other partner or director, ever had any insurance Details of Care Home Is the home currently occupied? Is the property currently trading as a care home? Type of care home: Details of Residents Please state the minimum age of residents: Please state the maximum number of Number of residents currently in the home: Mental Illnesses Does the home provide residential accomodation for any
Please Select
No
Yes
If yes, give details including numbers, ages & cause of detention: In respect of homes caring for residents with mental health problems or learning disabilities: (i) Explain the nature and severity (ii) Does the home accept clients with a history of
Please Select
No
Yes
If yes, please provide details of they are Have there been any incidents
Please Select
No
Yes
If yes, please provide details: Additional Risk Information Does the home offer any surgery post operative care?
Please Select
No
Yes
If yes, please state the percentage: Please list arrangements for services made available Are any of the above services provided by you or your employees?
Please Select
No
Yes
If yes, please provide details: If no, do you ensure that the practitioner holds
Please Select
No
Yes
Do you provide Care in the Community?
Please Select
No
Yes
Do you provide Sheltered Accomodation?
Please Select
No
Yes
Do you provide Day Care?
Please Select
No
Yes
Do you provide any recreational facilities?
Please Select
No
Yes
If yes to any of the above, please give details: Are the residents/patients needs assessed and documented?
Please Select
No
Yes
Are staff in attendance 24 hours a day?
Please Select
No
Yes
Claims Experience Have you or any previous owner, director or partner of the If yes, please provide details i.e. date of claim, Health & Safety Does the home comply with Health and Safety, Does the home have a written Health and Safety Does the home have a specific action plan with regard Are regulators fitted to restrict the temperature of hot water Is a pre-employment health questionnaire completed Are all staff properly trained in lifting techniques and is the Building Construction Construction of the walls (e.g. brick, stone, etc.) Construction of the roof (e.g. tile, slate, etc.) (If flat, state if 'felt/bitumen' or 'concrete') Percentage of flat roof (if applicable) Construction of floors (e.g. concrete, wood, mixed, etc.) Approximately, what year was the property built? Is the building purpose built or converted? Is the property a listed building?(e.g. grade I, II, II* etc.)
- Please Select -
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Has any part of the property ever been
- Please Select -
No
Yes
If yes, please provide details:(e.g. type of damage, date of How far away is the property from the Fire Protection Is a fire alarm installed? If yes, please state type of fire alarm signalling:
- - - - Please Select - - - -
Bells Only
Central Station Monitored
