General Information Please state the number of years you Please state the number of years you If you have purchased an existing care
Please Select
N/A
No
Yes
If not, please provide details: Care Standards Act 2000 Is the home registered under the Care Standards Act 2000?
Please Select
No
Yes
If yes, which category of service are you registered to provide for? Care home only Care home with nursing Care home providing adult placement Care home not providing medicines or medical treatment Details of Residents Please state the minimum age of residents: Please state the maximum number of Mental Illnesses Does the home provide residential
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 Are any of the above services
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
Please Select
No
Yes
Number of residents currently in the home: Are staff in attendance 24 hours a day?
Please Select
No
Yes
Proposers History / Claims Experience Have you or any other partner or director, Have you or any other partner or director, Have you or any previous owner, If yes, please provide details i.e. date of claim, Health & Safety Does the home comply with Health Does the home have a written Health Does the home have a specific action plan Are regulators fitted to restrict the Is a pre-employment health Are all staff properly trained in lifting techniques 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) 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*
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 high is the property above the
