solihull.gov.uk

Provider Closure

* CQC Registered Provider name

* CQC Registered Provider ID number (e.g. 1-xxxxxxxxx)

Owner details

* Contact name

Telephone number

* Email

* Postal address

CQC Details

If this change effects more than one location under the same provider, you will need to complete a form for each location.

* Current CQC registered location name

* Current CQC registered location ID number (e.g. 1-xxxxxxxxx)

Have the CQC been notified of the change you are informing us about

* Which of your contracts will this change effect (e.g. care home, supported living, homes support, home support specialism)

Registered manager details

Telephone

* Email

* Postal address

Provider closure

* Please provide the number of Solihull residents you support

* Please provide the total number of people that are wholly or partly funded by Solihull Council

* Please provide total number of people that are funding their own care

* Please provide the total number of who are wholly or partially funded by another Local Authority

* What is the expected date of closure (DD/MM/YYYY)

Data Protection

Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services or benefits you may be entitled to or interested in. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk.