Quotation Request

Care Home

Disclosure
Proposer Details
Premises
Cover Details
Risk Information
Covid H&S Questions
Claims

Disclosure Statement:

When taking out insurance wholly or mainly for purposes related to your trade, business or profession, you have a duty under The Insurance Act 2015 to make a fair presentation of the risk. This means that you must disclose every material circumstance which you and/or your senior management and/or anyone responsible for arranging your insurance know or ought to know. Alternatively, you must disclose sufficient information which would put the insurer on notice that it needs to make further enquiries for the purpose of revealing those material circumstances. You are expected to carry out a reasonable search in order to make a fair presentation of the risk and will be deemed to know what should reasonably have been revealed by the search.

Your duty of fair presentation applies at the start of the policy, at renewal and when any variation of the policy is arranged. If you fail to make a fair presentation, the insurer may refuse to pay your claim or reduce the settlement amount, depending on the circumstances.

I have read this statement:

Incorrect information could invalidate all or part of the Policy. Please confirm if the Proposer agrees to the following statements:
Neither the Proposer, nor any directors or partners in the business have ever:-
had an insurance contract cancelled by an insurer.
Please provide full details:
had an insurance contract declared void by an insurer.
Please provide full details:
had different terms applied to an insurance contract by an insurer due to misrepresentation by:

  • providing misleading or incorrect information

  • deliberately or recklessly withholding information

  • providing false documents

    • Please provide full details:
    had insurance cover restricted or cancelled due to non-compliance with risk improvement requirements.
    Please provide full details:
    been convicted of or charged with but not yet tried for a criminal offence other than motoring offences.
    NOTE: Spent convictions (as defined under the Rehabilitation of Offenders Act 1974 or any similar or subsequent legislation) do not need to be declared.
    Please provide full details:
    Health & Safety
    Neither the Proposer, nor any directors or partners in the business either personally or in connection with the business or in any other business capacity has ever been:-
    convicted of (or charged but not yet tried with) a breach of any UK health and safety legislation by any official body regulatory authority or enforcing authority.
    Please provide full details:
    served with a prohibition notice or improvement notice in connection with any UK health and safety legislation by any official body regulatory authority or enforcing authority.
    Please provide full details:
    served with a clean-up notice in connection with any UK health and safety legislation by any official body regulatory authority or enforcing authority.
    Please provide full details:
    All lifting plant and pressure vessels/boilers which are subject to Statutory Regulations are regularly inspected by qualified engineers as required by the legislation.
    To the best of their knowledge the proposer complies with their legal obligations under UK health and safety legislation.
    Financial
    Neither the Proposer, nor any directors or partners in the business or in the name of any other business which any of us had an interest have:-
    been declared bankrupt or insolvent either as private individuals or in connection with any business within the last ten years.
    Please provide full details:
    been disqualified from holding a directorship.
    Please provide full details:
    been the subject of a County Court Judgement (or the Scottish equivalents) in respect of debt as private individuals or in connection with any business within the last six years.
    Please provide full details:
    been a director or partner in a business that has been the subject of a County Court Judgement (or the Scottish equivalents) in respect of debt within the last six years.
    Please provide full details:
    been officers of a company that has been declared insolvent, or had a receiver or liquidator appointed, or entered into arrangements with creditors in accordance with the Insolvency Act 1986 within the last ten years.
    Please provide full details:
    Has the company traded at a loss in any of the last 5 years?
    Is the Care Home registered in line with appropriate legislation?
    What was the date of your latest inspection report?

    Proposer Details

    Inception Date
    Proposers name and trading name in full
    i.e. Mr & Mrs John Smith t/as The White Horse
    Contact Name
    Date of Birth
    Contact Number
    Mobile Number
    Email Address
    Company Number
    Business Description:
    The definition of Elderly includes mentally and/or physically disabled individuals and those with learning difficulties where in excess of 75% of service users are over the age of 55 years.
    Reason for being ERN Exempt:
    Is the Proposer a member of any associations? If so, which?
    Is there a Third Party Interest to be Noted?
    Third Party Interest
    Risk Address

    Premises

    The Premises / Buildings of the Business being proposed:
    have walls built of brick, stone or concrete?
    Please provide full details:
    have a roof of slate, tile, metal or concrete, excluding any flat roof area?
    Please provide full details:
    Please advise construction?
    Has any flat felted roof on the premises been professionally inspected and any defects repaired within the last 2 years?
    are in a good state of repair and kept in a like manner?
    have a listed status?
    What Grade?
    Please advise what year the premises was built:
    trade all year round?
    Please provide full details:
    i.e. when is the business closed, does the owner/employee live on whilst the premises are closed, etc.
    are entirely self contained?
    i.e. with a separate lockable entrance and exit
    Please provide full details:
    are occupied solely by the business?
    What is the nature of the other business/businesses?
    have residential accommodation above the premises other than that which acts as the private dwelling of the proposer or their employees?
    Is residential accommodation let to Students, Asylum Seekers, Refugees or persons who receive Housing Benefits directly or indirectly?
    Please provide full details:
    i.e. who resides, is the lease directly with the tenant, etc.
    have staff on site 24 hours a day, 7 days a week?
    are free from storm exposure and/or are in an area which is free from flooding and at least 400 metres away from the nearest river, canal, lake or tidal waterway?
    Please provide full details:
    are free from, and in an area (within 400m of the premises) which is free from any signs of subsidence, heave and/or landslip?
    Please provide full details:
    i.e. when did the subsidence/landslip/heave occur, what has been done to the premises since, etc.
    had the Electrical Installation tested by a certified NICEIC, ELECSA or ECA Contractor within the last 5 years and all reported defects remedied?
    has an open fire, woodburning or multifuel stove?
    has an up to date Fire Risk Assessment?
    thoroughly protected by a fire alarm system, under the sole control of the insured?
    What type of fire alarm is installed?
    Is the fire alarm annually maintained?
    Who is the fire alarm maintained by?
    has an operational sprinkler system?
    Please provide full details:
    i.e details of the system installed

    Cover Details

    Signs
    Premium Charged
    £
    Please provide full details:
    Playing surfaces, Artificial Surfaces and Floodlights
    Maximum Sum Insured in respect of Floodlights is £15,000
    £
    Trade Contents, Fixture & Fittings (Ex. Stock in Trade)
    £
    Computers (maximum £15,000)
    £
    Property in the Open
    Premium Charged
    £
    Please provide full details:
    Residents Effects

    Up to £3,000 per guest

    Excludes Jewellery, Antiques and Works of Art

    £
    Stock
    £
    Deterioration of Stock
    £
    Goods In Transit
    £
    Money During Business Hours and In Transit
    £
    Money in Locked Safe outside Business Hours
    £
    Book Debts
    Maximum £100,000
    £
    Fidelity is automatically included at £5,000
    Business Interruption
    £
    Number of Employees
    Number of Volunteers:
    Weekly hours worked by volunteers:
    Estimated Annual Turnover
    £
    Estimated Annual Wageroll
    £
    Employers' Liability is automatically included at £10,000,000
    Public & Products Liability is automatically included at £5,000,000
    Malpractice is automatically included at £5,000,000
     

    Risk Information

    Number of Beds
    Are all residents over the age of 55?
    What percentage of residents are under the age of 55%?
    %
    Is there an appointed individual who maintains appropriate safeguarding policies and procedures?
    Please provide full details:
    Are any doctors or medical staff employed to attend to residents needs?
    Are any non-medical staff involved in the administration of prescriptive medicines?
    Please provide full details:
    Do you employ agency staff?
    Please provide full details:
    e.g. type of agency, type of staff
    What Percentage?
    %
    Do you have policies and procedures in place for DBS checking for all staff?
    Do any residents have a history of challenging behaviour?
    e.g. One or more incidents where the resident has had to be restrained within the last 12 months
    Please provide full details:
    Do you accept residents with criminal convictions?
    Please provide full details:
    Do you provide any care in the community?
    What is the turnover generated from care in the community?
    £
    Is there a written Health & Safety policy in force?
    Has a Health & Safety Risk Assessment of the premises been carried out?
    A formal procedure is to be established that periodically audits the effectiveness of the companies health and safety documentation and procedures against best practice and to ensure that it reflects the hazards and risks to which the organisation and its employees and visitors are exposed. Once reviewed the documents should be signed and dated by a director and brought to the attention of all employees on a signed receipt basis.
    Are staff properly trained in lifting techniques and a written record kept?
    Are pre-employment questionnaires completed for all prospective employees?
    Do residents have their own cooking facilities within individual rooms?
    Please provide full details:
    Is frying undertaken at the premises, other than shallow frying?
    Is there a full frying range (fish & chip shop style) located and used at the premises?
    i.e. Traditionally found in a Fish & Chip Shop
    Are the kitchen and/or canopy hood, range extraction systems and ducting annually maintained and cleaned by professional contractor?
    Is the Range maintained and cleaned at least once a year by an independent contractor?
    Is the kitchen range within the premises protected by a kitchen fire suppression system that conforms to BS standards and is annually maintained?
    The kitchen fire suppression system must be installed and maintained in accordance with BS EN 16282-7:2017+A1:2021 with acceptable systems including (but not limited to) Ansul, Spoon2 and Ceasefire.
    Is a Pressure Cooker used at the premises?

    Covid H&S Questions

    How many confirmed cases of COVID-19 have there been in your care environment to date?
    Number of Residents
    Number of Employees
    Number of Volunteers
    Have there been any resident fatalities where COVID-19/Coronavirus has been specified on the death certificate and the resident had not been in hospital or other residential care during the outbreak?
    Number of Deaths
    Date of last recorded death
    Have there been any employee fatalities where COVID-19/Coronavirus has been specified on the death certificate?
    Number of Deaths
    Date of last recorded death
    The Government published the Adult Social Care Action Plan on 15th April 2020 to reduce outbreaks in care homes; support care staff and providers and maintain independence of those receiving care.
    Prior to the publication did you have suitable precautions in place to isolate any resident that was suspected of contracting COVID-19?
    Were these precautions recorded and did you formally communicate these to your staff?
    Following the publication did you review your procedures in line with the revised Government guidelines?
    Did you record this review and communicate it to all relevant Employees?
    A risk assessment must be carried out and hazards identified in managing a COVID-19 outbreak. Following these risk assessments safe operation procedures/safe systems of work should be produced.
    Have you carried out a formal risk assessment and put safe operating procedures/safe systems of work in place in respect of an outbreak of COVID-19?
    Have these risk assessments and safe operating procedures/safe systems of work been regularly reviewed in line with the Public Health England, Health Protection Scotland, Public Health Wales or Public Health Agency (Northern Ireland)?
    Have you formally recorded these reviews, and can you demonstrate any changes have been effectively communicated to employees?
    Have audit checks been carried out to ensure all staff are adhering to your safe operating procedures/safe systems of work for managing COVID-19?
    Is there a procedure in place to identify any areas of non-compliance and implement necessary improvements?
    Have you reviewed your visitor policy in line with Government guidelines?
    All care organisations need plans in place for the testing of employees and residents of Covid-19. These plans need to be regularly reviewed in line with Government guidelines.
    Please advise the percentage of employees and residents who have had a COVID-19 test
    %
    Please advise the date of when the 1st test was carried out:
    Have you recorded the results of all employee and resident COVID-19 tests that have been undertaken?
    Has testing been in line with Government guidelines at all times?
    All employees should have received infection control training.
    Has specific COVID-19 training been provided to all employees?
    Do you have training records that demonstrate specific COVID-19 training?
    Was this training carried out by a competent person and can you demonstrate the learning objectives of the training?
    Have training needs been reviewed on a regular bases and additional training provided where necessary?

    Personal Protective Equipment

    Have you reviewed your risk assessments since the outbreak of COVID-19 in respect of the provision of PPE in line with Government guidelines?
    Have you had shortages of PPE during the outbreak?
    If there have been shortages of PPE have you reviewed your risk assessments and safe operating procedures/safe system of work to ensure all employees were suitably protected during this time?
    Did the NHS take any of your PPE supplies?
    Do you have any documentation to support this?
    Do you want to provide anymore information?
    Please provide full details:

    Claims

    Has the Proposer(s), Partner(s) or Directors(s) suffered a loss, claim or incident (which may give rise to a claim) at these premises, or any other premises, whether insured or not within the last 5 years?
    Please provide details:
    Date Type of ClaimDetails PaidReserveMeasures Taken
    Add row

    Additional Information

    Do you want to bring any additional information to the underwriters attention?
    Please provide full details:
    New Question
    Target Premium
    £
    Stay in touch...

    We'll automatically email you your quotation, including a link so you can easily retrieve all your quotes. We'd like you to be the first to know about latest offers, news, products and promotions. You can let us know at any time if you change your mind. Further information can be found in our privacy policy which will be included in your quotation pack.

    You'll receive newsletters full of interesting news and money saving ideas and other information about our other products and services that we think you'll be interested in. We may keep in touch via email, SMS, phone, post and other electronic means such as via social and digital media.

    Would you like to receive these updates from us?