Phoenix Specialist Risk Solutions Domiciliary care fact find Business name Office address Contact Name Phone number Email address Current insurance arrangements Renewal date Renewal premium Broker Current Insurer Sums insured Buildings (if owned) Contents Last 12 months audited turnover (annual income) Projected turnover for the next 12 months Last 12 months Carers' wage roll including employer's cost Projected Carer's wage roll including employer's costs for the next 12 months How many clients do you have? Client services If yes to any of the questions below, please detail how the service is managed to ensure the risk of injury or damage is minimised. Do you do PEG feeds and/or Tracheotomy care? Do you do PEG feeds and/or Tracheotomy care? *YesNo If so, is this service provided by qualified and registered nurses? Do you provide live-in 24-hour care? Do you provide live-in 24-hour care? *YesNo If so, do you rotate carers? At what intervals? Do you administer by injection? (Diabetic Insulin etc) Do you administer by injection? (Diabetic Insulin etc) *YesNo If so, is this service provided by qualified and registered nurses? Do you provide care to anyone under the age of 18? Do you provide care to anyone under the age of 18? *YesNo If so, what services? Personal Care Personal Care *YesNo Nursing Care Nursing Care *YesNo Domestic Duties Domestic Duties *YesNo Administration of Drugs Administration of Drugs *YesNo Gardening and Handyman Gardening and Handyman *YesNo Respite Care Respite Care *YesNo Business activities Please describe the activities of your organisation Do you have a registered manager in accordance with CQC requirements Do you have and maintain an accident book? Regulatory report Do you have any outstanding requirements? Do you have a locked cabinet/locked room/trolley for safely dispensing drugs and a robust MAR procedure? In addition to CQC mandatory training, do you provide staff with any additional training? Do you undertake reference checks, DBS checks and other background checks? Document Retention - are staff records including DBS, background, reference, training, accident retained securely? Are patient records, including care plans, referrals, incidents retained securely? Management controls Do you undertake/use the following procedures? Do you undertake/use the following procedures? A) Ops manual and staff training & supervision programme B) Health & safety system C) Protection of Vulnerable Adults (POVA) policy D) Accident reporting policy E) Staff vetting (inc DBS/references) F) Induction training policy (accompanying new staff on initial visits etc) G) Refresher training policy (annually) H) Incident reporting policy I) Quality control system J) Do you undertake references? K) Do you undertake ID checks? Please detail any additional risk management or mitigation which you feel may be useful to Underwriters Internal security features Computer systems and record keeping How are you made aware of any untoward incidents? How is your computer system managed to protect data? Do you have an intruder alarm? Do you have an intruder alarm? *YesNo If yes, is this central station monitored? Do you have a fire alarm? Do you have a fire alarm? *YesNo If yes, is this central station monitored? Do you have a sprinkler system? Do you have a sprinkler system? *YesNo If yes, is this maintained annually by a competent contractor? Any claims or losses in the past 5 years? Date of claim Amount paid/reserved Details of claim/losses Do you have any more claims or losses to add? Do you have any more claims or losses to add? *YesNo Date of claim Amount paid/reserved Details of claim/losses Do you have any more claims or losses to add? Do you have any more claims or losses to add? *YesNo Date of claim Amount paid/reserved Details of claim/losses Do you have any more claims or closses to add? Do you have any more claims or closses to add? *YesNo Date of claim Amount paid/reserved Details of claim/losses Do you have any more claims or losses to add? Do you have any more claims or losses to add? *YesNo Date of claim Amount paid/reserved Details of claim/losses Some of the information provided may give rise to additional information being required, we will endeavour to make this process as easy as possible for you. How would you prefer to be contacted for the additional information? Some of the information provided may give rise to additional information being required, we will endeavour to make this process as easy as possible for you. How would you prefer to be contacted for the additional information? Phone Email Name Position Date 7 + 9 = Submit
