The Care Homes Regulations 2001, Regulation 5, requires each Care Home to compile a written guide to the Care Home which is referred to in the Regulations as “The Service Users Guide”.
The aim of this Services Users Guide is to enable you or your representative to:
Make such decisions as may be required about the suitability of the Care Home to meet your present and future needs prior to moving into the Home.
Make valued judgements as to whether the Care Home is continuing
to provide the level of services that was specified as part of your Terms and Conditions of Residency.
Ensure that your views are taken into consideration and that you have a real say in the development of services available to you in the Home.
Provide you with information regarding the views of external regulatory bodies.
The Service User Guide is designed to provide you with important information about the running of the Home and your rights as a resident. If you would like any assistance with understanding of the Service Users Guide then please ask a member of our senior staff who will be pleased to help you.
SUMMARY OF THE STATEMENT OF PURPOSE
A DESCRIPTION OF THE CARE HOME AND THE PHYSICAL ENVIRONMENT
Woodrow is located within a part of Torquay known as the Lincombes.it is situated on the north-west side of Asheldon Road, at the junction of Asheldon Road and Babbacombe Road (A379). Asheldon Road is laid out as a crescent, and Woodrow is positioned on the outer edge of the crescent layout, with gardens extending to the north-east and south-east of the building. The site lies within the Lincombes Conservation Area. Woodrow is a late-19th century detached villa. The building was designed in the Italianate style, and the exterior of the building displays a number of architectural features in the Classical style, such as pilasters, and dentil cornices. The building has been extended a number of times, including extensions to the north-east, and north-west elevations. There is a late 20th century conservatory attached to the southern corner of the building Woodrow is within walking distance of” Wellswood Village” There are many shops, a public house, pharmacy, restaurants and the local church of St. Mathias
Woodrow has 17 rooms All rooms comply with regulation sizes they are light spacious, and very comfortable There are 10 on the ground floor; which consist of 2 bedroom sitting rooms with bathrooms en suite, 1 bedroom sitting room toilet en suite, 1 bedroom sitting room wash basin en suite, 3 bedrooms bathrooms en suite, 1 bedroom toilet en suite Woodrow has a stair lift to the 7 rooms on the first floor, consisting of 1 bedroom sitting room with bathroom en suite, 3 bedrooms with bathrooms en suite, 2 bedrooms with toilet and washbasins en suite, 1 bedroom with washbasin en suite & 2 bedrooms with wet rooms en suite. All the facilities are centrally heated, have digital television points, and are fitted with call alarm system, offering quality individual features and comfort.
Bathrooms are adapted to assist the disabled. There is a Parker bath, electronic hoist, lifting aids and disabled toilet facility in the main bathroom on the ground floor, to meet the client’s individual needs.
All the equipment at Woodrow meets the regulatory standards and is certified at the correct times
Residents are encouraged to bring in personal items of furniture to personalise their own space as long as it meets safety standards. Woodrow provides furniture that meets the National Standards.
Woodrow is equipped with lifting and bathing aids to meet the needs of client’s individual needs. Other aids and equipment are assessed and provided by Occupational Therapist and District Nurses.
Woodrow is cleaned on a daily basis the Manager strives to maintain the building and the environment to a high standard.
Woodrow is centrally heated all radiators are regulated and have individual thermostat controls. All rooms have adequate ventilation.
There is a full fire detection and alarm system that is maintained and complies with regulation.
AIMS OF THE HOME
To provide quality services for residents by caring, competent, well trained staff.
To foster an atmosphere of care and support which both enables and encourages our residents to live as full, interesting and independent a lifestyle as possible with rules and regulations being kept to a minimum. Residents of both sexes over the age of 65 can be accommodated.
Woodrow is committed to providing quality services for ladies and gentlemen, by caring competent, well-trained staff in a homely atmosphere.
This will be achieved by:
Staff development and training programme.
Providing such resources as may be required to ensure that training takes place and is effective.
Recruitment of staff that share our values and will care for residents to a high standard
Woodrow will provide services based upon consultation and assessment of the residents’ needs.
This will be achieved by:
Listening to staff, guests and others with an interest in the Home. Ensuring that assessments are made which balance risks and needs. Promoting a level of responsible risk-taking in daily living activity. The operations of an effective care planning system.
Woodrow will involve guests in the planning and review of the services that are provided for them to ensure that their needs are met.
This will be achieved by:
Enabling and empowering guests to influence the services provided in the home by giving each guest a real say in how services are delivered. Encouraging guests to become involved in all decisions, which are likely to affect them, either now, or in the longer term.
Woodrow will consult people about their satisfaction with the service and suggestions for improvement.
This will be achieved by:
Residents’ reviews and satisfaction surveys. Residents meetings.
Woodrow will provide catering services, which meet the expectations of guests
This will be achieved by:
Planned, structured menus, which include guests’ wishes, choices and preferences.
Menus, which are nutritionally balanced.
Menus that allow guests to change their food choices.
Woodrow will ensure that guests are fully informed about all matters, which might affect their well being.
This will be achieved by:
Notices that will inform guests by being displayed on the resident’s information board.
Woodrow will offer a range of social activities, which meet the needs of the residents.
This will be achieved by:
Ensuring that activities are offered to each resident, which are appropriate to their needs, abilities or expressed wishes?
Ensuring that the Home considers their social, spiritual, cultural, emotional and physical needs in the services it offers to residents.
Ensuring that guests feel comfortable to decline any or all of the activities offered by the Home.
Woodrow will ensure that the Home is a safe and secure place to live.
This will be achieved by:
Ensuring that the physical environment meets all Health and Safety standards.
Providing each resident with a safe and secure place to store his or her valuables.
Woodrow will afford all residents and staff an equality of opportunity in respect of living or working in the Home.
This will be achieved by:
An Equal Opportunities Policy.( available in office)
The right to be called by the name of your choice.
The right to care for yourself as far as you are able.
The right to take personal responsibility for your own actions and expect all staff to accept that a degree of risk is involved.
The right to personal privacy at all times and a right to lock your own room . The right to invite whomever you choose into your room.
The right to independence.
The right to have your dignity respected and to be treated as an individual. The right to receive an anti-discriminatory service, which is responsive to your race, religion, culture, language, gender, sexuality, disability and age. The right to live your chosen lifestyle.
The right of access to your own personal records and information relating to decisions made with all staff that affect your life, and where necessary to be assisted with this.
The right to take part in any decisions about daily living arrangements that affects your life.
The right of access to outside agencies of your choice e.g. doctor, optician, chiropodist etc., and where necessary to be assisted with this.
The right to look after your own medicines.
The right to control your own finances, if you are able to do so.
The right to make personal life choices such as what food you eat and what time you get up and go to bed.
The right to be involved in your own care plan and be involved in any formal reviews of your needs, which take place at regular intervals.
The right to access a formal complaints procedure and to be represented by a friend, relative or adviser if necessary.
The right to participate in voting at elections.
NUMBERS, QUALIFICATIONS AND EXPERIENCE OF STAFF
Woodrow is staffed in accordance with the requirements of Regulation 18 of the Care Homes Regulations 2001. In particular, we will ensure that as is reasonably possible there will be suitably qualified competent and experienced staff in sufficient numbers as are appropriate for the health and welfare of residents. Full details of Names, qualifications and experience of our staff is held in our List of Staff Employed in the Home, which is kept in the office and may be inspected at any reasonable time”.
Information regarding the registered Home Manager
The Manager is Mr Peter Edwards contact address as per front cover. Peter has worked in the care sector caring for older people since 1980. His qualifications include. The Registered Managers Award, and NVQ Level 4 in Care
Information relating to the Registered Provider The Registered Provider is:
Woodrow Retirement Home Ltd
The registered office is:-
Channon & Co
“ The Mill “ Kingsteignton Road Newton Abbot Devon
The Director is Mr. Peter Edwards
Mr. Peter Edwards is the Responsible Individual who will be undertaking regular inspections under Regulation 26.
Mr Peter Edwards has been the Registered Provider and Registered Manager of Woodrow care home since 1984. Woodrow Retirement home intends to remain financially viable, comply with all relevant legislation, to re-invest in the home and remain fit for the future.
AGE RANGE AND SEX OF SERVICE USERS
Our Care Home provides long-term care for 16 clients aged over 65 years for both male and female.
RANGE OF NEEDS THAT WOODROW IS INTENDED TO MEET
Woodrow provides services in the following categories: Care Home providing personal care
Woodrow provides services in the following categories of resident: Old age and disability
NURSING CARE PROVISION
Woodrow does not provide nursing care for residents in the Home, although the District Nurses visits our home on referral from the GP’s.
MEDICAL CARE – QUALIFIED CARE STAFF
Competent trained staff are always available to plan and supervise resident’s care, ensuring the highest standards at all times. GP’s visit on request, residents may of course retain their own Doctor if this is practical. Community nurses and primary care team staff will visit residential care residents as appropriate.
OPTICIAN AND DENTIST
Knapman Hayes Opticians, visit regularly although you are free to make appointments outside if you prefer. The National Health community dentist will also visit upon request.
A private chiropodist visits the Home regularly and is charged for separately. Any resident qualifying for the service of the health authority chiropodist is treated free of charge. This can only be arranged through GP referral.
Physiotherapy can be arranged as necessary usually after GP referral. Private physiotherapy can also be arranged on request
A hairdresser visits weekly at an extra charge, basic hair care is provided by the care staff. Outside appointments can also be arranged.
Our catering staff will carefully prepare your meals; meals are as interesting and varied as possible. Guests are offered choices each day and special diets will be catered for.
Choices are available at all meal times The day usually begins with an early morning cup of tea followed by cooked breakfast or fruit juice, fruit, cereals and toast.
Mid-morning tea,coffee and biscuits, three course lunch, mid-afternoon tea/coffee and cakes. Two course evening meal followed by supper drinks and snacks. Fresh fruit is always available and offered daily.
All meals, snacks, supplements and drinks are provided within the fees for service. Special diets are catered for and advice of the dietician is sought where necessary. Limited quantities of alcohol are offered at the request of clients.
The business telephone number is 01803 213026
Facilities are also made available for clients that require a personal line
This is available in the Home via the care staff on duty.
Benefits advice can be provided via the Manager. Information can be obtained about Pension and Social Security Benefits.
Where appropriate we encourage guests to go shopping on their own, with relatives or a staff member. Where this is difficult staff can assist residents by purchasing goods on their behalf within the necessary safeguards of our Personal Finance Policy and Procedure.
A full laundry service is provided in the home within the normal fees for service. The Home expects all personal clothing to be labelled and cannot be held responsible for any loss of items not so marked.
Can be provided at cost plus a service charge and can be arranged through the care staff.
Comply with the standards laid down by the Environmental Health Department. The Cook manages the Kitchen.
Drinks and snacks are available at any time for residents upon request.
ARRANGEMENTS FOR REVIEWING YOUR PLAN OF CARE
Westwood operates a care planning and review system. On admission each resident is assessed and a plan of care formulated. This plan will cover all areas of a resident’s life and will not focus purely on problems and physical matters but aim to enhance the resident’s quality of life; this is then reviewed on a monthly basis. Any persons involved in the care of a resident are invited, at least annually to discuss, review and revise a care plan
ARRANGEMENTS FOR ATTENDING RELIGIOUS SERVICES
Woodrow takes all reasonable steps to ensure that each residentswishes are known and understood in relation to the practice of their chosen religion. Where requested, we will observe and ensure confidentiality in respect of religious belief or alternatively we will take such steps as may be necessary to enable residents to attend religious services or access religious leaders, ministers or priests in private
ARRANGEMENTS FOR SOCIAL ACTIVITIES, HOBBIES AND LEISURE INTERESTS
Woodrow is able to provide a variety of ways that residents can engage in the enjoyment of social activities, hobbies and leisure interests. Residents are consulted individually in relation to their interests and wishes regarding social activities as part of the Service User Planning process.
The range of activities available is set out below:
Aromatherapy massage, exercises and games with Motivation & Co. Daily in-house activities with care staff. (See activities book)
ARRANGEMENTS FOR PETS
Relatives may bring pets in to the home for a visit provided they are well behaved.
ARRANGEMENTS FOR RESIDENT CONSULTATION ABOUT THE HOME
Woodrow is committed to ensuring that residents are fully consulted about matters which are significant in the running of the Home or about matters which might affect their well being or quality of life. Management and staff are available to listen to the views of residents.
ARRANGEMENTS FOR MAINTAINING CONTACT WITH RELATIVES, FRIENDSAND REPRESENTATIVES
Westwood actively encourages residents to maintain all forms of social contact that they enjoyed before moving into Woodrow. We will assist residents to maintain contact if requested.
Woodrow is looked upon as a resident’s home and hence, subject to the resident’s wishes, visitors are, within reason, generally welcome at any time. It would however be preferred not to have visitors at meal times unless clients are in their own room or a visitor wishes to join the client for a meal. All visitors are requested to enter their details in the ‘Visitors Book’ and to sign out on departure. Visitors should be made aware that this is to comply with Care Home Regulation 17 & Schedule 4(17), Health & Safety legislation and Fire Regulations. Residents can usually receive visitors in their own room or in one of the lounges or, outside meal times, in one of the dining rooms. Visitors wishing to take residents off the premises should speak to the seniormember of staff on duty first to ensure that any medication can be provided and that the trip out, is within the capacity of the resident. This needs noting in the Visitors Book on departure and return. Relatives and friends are encouraged to attend social events such as resident’s Christmas Party, Summer Fair, entertainment evenings and outings.
The Home will not accept any liability whatsoever for loss of or damage to any money or other valuable property kept (or said to be kept) by the resident in or about the Home unless such money or property shall have been:
♦ Identified to the Home in writing with a current written valuation.
♦ Deposited within the Home’s safe for safekeeping .
PROVIDED THAT, in the case of money, liability will not be accepted unless the money is deposited with the Home for safekeeping, and in no event whatsoever for sums exceeding £500.
In the case of all other property the Home’s liability in respect of any item shall not exceed £500. For items above £500 the individual resident is solely responsible for a separate insurance policy to cover that risk
GIFTS AND SIGNING LEGAL DOCUMENTS
The Home’s employees or staff are not permitted to directly accept any gifts, and / or presents from residents or to sign as a witness any legal document which
ARRANGEMENTS FOR RESIDENT CONSULTATION ABOUT THE HOME
Woodrow is committed to ensuring that guests are fully consulted about matter which are significant in the running of the Home or about matters which might affect their well being or quality of life. Management and staff are available to listen to the views of guest
ARRANGEMENTS FOR MAINTAINING CONTACT WITH RELATIVES, FRIENDS
Woodrow actively encourages guests to maintain all forms of social contact that they enjoyed before moving into Woodrow care Home. We will assist guests to maintain contact if requested.
Woodrow is looked upon as a home and hence, subject to the guests wishes, visitors are, within reason, generally welcome at any time. It would however be preferred not to have visitors at meal times unless guests are in their own room or a visitor wishes to join the guest for a meal.
All visitors are requested to enter their details in the ‘Visitors Book’ and to sign out on departure. Visitors should be made aware that this is to comply with Care Home Regulation 17 & Schedule 4(17), Health & Safety legislation and Fire Regulations. Guests can usually receive visitors in their own room or in the lounge or, outside meal times, in the dining rooms. Visitors wishing to take Guests off the premises should speak to the senior member of staff on duty first to ensure that any medication can be provided and that the trip out is within the capacity of the guest, this needs noting in the Visitors Book on departure and return.
Relatives and friends are encouraged to attend social events such as the Christmas Party, Summer Fair, entertainment evenings and outings.
The Home will not accept any liability whatsoever for loss of or damage to any money or other valuable property kept (or said to be kept) by the guest in or about the Home unless such money or property shall have been: Identified to the Home in writing with a current written valuation. Deposited within the Home’s safe for safekeeping.
PROVIDED THAT in the case of money, liability will not be accepted unless the money is deposited with the Home for safekeeping, and in no event whatsoever for sums exceeding £500.
In the case of all other property the Home’s liability in respect of any item shall not exceed £500. For items above £500 the individual resident is solely responsible for a separate insurance policy to cover that risk.
GIFTS AND SIGNING LEGAL DOCUMENTS
The Home’s employees or staff are not permitted to directly accept any gifts, and / or presents from guests or to sign as a witness any legal document which pertains to one of the guests in the Home.
ARRANGEMENTS FOR DEALING WITH COMPLAINTS
Woodrow welcome any Comments, Concerns or Complaints about the services delivered or how to improve the running of the Home. Complaints or Concerns about the service provided within our Home will be treated seriously.
If a guest or relative requires help to make a complaint then they should be afforded advice about potential advocates.
FINANCIAL ARRANGEMENTS and FEES
We are committed to providing value for money within our comprehensive and caring service The fees charged are dependent on:
The type of facility required, and
The type of care package and needs of the individual Service User
Depending on the personal financial situation, a Service User can either pay the fees privately or receive benefits arranged by social services.
The current rules can be complicated and specific advice is available from the Home Manager.
Fees – What is included
Fully trained staff in 24 hour attendance
Quality Home Cooking on the premises, with a choice to have meals in the privacy of their own room
Snacks and a variety of hot and soft drinks available 24 hours a day. Provision for Special Diets and Menu Requests
Individual care of clothing and possessions
Full Central Heating and Electricity
Access to public telephone.
Storage space provided for clothes and belongings
An acknowledgment by staff of the privacy of service users by knocking and waiting for a reply.
To clean and care for their personal effects in their room.
The recognition of every Service Users individual need to have some time to themselves.
Flexible timetable to allow Service Users to make their own choices.
All drugs and medication ordering on a regular basis and administered by staff or self administration where possible.
Service Users encouraged to have guests for lunch, afternoon tea or supper.
Gardens and grounds set out and maintained to allow service users full use and enjoyment.
Fees – What is not included
Weekly visits from the hairdresser/ Chiropodist to the home
Visiting Dentist and Optician
Private Telephone Line connection to room
Accompanied visits to hospital, or appointments(these will be charged at a nominal rate)
Daily Newspapers and Magazines
If a Service User wants to be self-medicating, a Risk Assessment will need to be signed, help and advice is given. Otherwise all drugs will be managed by the staff and dispensed and ordered for them under the instructions of the Doctor. Any Service User may request to see a doctor in private if they wish. Relatives are asked if they wish to provide Homely Remedies, these must be discussed first with the Home Manager.
Care Quality Commission
This is a national body, which regulates the conduct of Care Homes in England. There are a number of regional offices from which officers carry out their duties. Westwood is part of the South West Regional Team
Care Quality Commission St Nicholas Building
St Nicholas Street Newcastle upon Tyne NE1 1NB
They can be contacted at the above address or by: Telephone: 01912333300 Fax: 01912333301
Leaving or Temporarily Vacating
If a person wishes to be discharged from the Home, then 4 weeks notice must be given of this intention, or 4 weeks fees paid in lieu of notice. These conditions are waived during the 4 week trial period. If a Service User temporarily moves out of the Home (e.g. to receive hospital treatment) the bed is retained indefinitely, provided full payment is made. In the case of social work funded Service Users, this retention period would be reviewed by the Home Manager.
If as a Service User, relative or visitor, you feel that there is cause for complaint, you should first discuss the matter with the person in charge, and request a form “Expression of Dissatisfaction “If the matter is in your opinion a serious one, or if you remain dissatisfied, you can record the complaint in the Complaints Register, which is available from Reception or from the person in charge. A full investigation will be made into the complaint, and you will be advised of the outcome within 28 days after the date the complaint is made.
If after this investigation, you are still not satisfied, or if you feel that the complaint is of a serious nature and you wish to speak to a representative of the “Torbay Care Trust” then you should contact the “Care Trust” Bay House Riviera Park Nicholson Road Torquay Devon TQ2 7ID Tel: 01803 210500
If you have a complaint or concern regarding impaired capacity the contact details for the “ Office of the Public Guardian” are PO Box 16185 Birmingham B2 2WH Tel 0300 456 0300
A copy of Woodrow complaint procedure is on display and can be made available on request
In the unfortunate event of bereavement, the family can expect every possible support and consolation from staff.
Whereas funeral arrangements are usually made by the next of kin, the Home Staff can be relied upon to assist and explain what is required. Where there is no next of kin, the staff will attend to the necessary arrangements
Contract of Residence
THIS AGREEMENT Is between Woodrow
And “THE SERVICE USER ……………………………………………..
Residence and payment of Care Fees:
1.Upon payment of the weekly charge as hereinafter defined in paragraph 2,
Woodrow undertake to provide accommodation, food, light, heat, laundry and all the necessary personal care as would normally be required by a Service User of a Care Home.
2. The monthly charge shall be the initial sum of £ per month paid one month in advance by cash, cheque or bankers order which it is agreed shall cover the provision of all services referred to in clause 1 above subject to review. The monthly charge shall remain unchanged unless one month’s written notice is given by Woodrow to the Service User or this agreement is jointly amended by all parties hereto.
3. Woodrow undertakes to maintain a standard of care as required by Registration Authority. If an occasion should occur where a complaint or query arises the Service User is referred to Woodrow written procedure for dealing with complaints. If the complaint is not resolved, the Service User may wish to refer to the: Care Quality Commission South West Region Citygate Gallowgate Newcastle-upon-Tyne NE1 4PA
4. This agreement shall continue in force until terminated by either party giving to the other written notice four weeks before termination. Should the Service User leave the home without giving the required notice, payment of fees in lieu of notice at the normal or revised weekly rate will be required.
The first four weeks of admission shall be regarded as a trial period for the benefit of the Service User and Woodrow .
6. Woodrow will be the abode of the Service User. Should a Service User at any time require hospital treatment or be otherwise temporarily absent from the Home, Woodrow will retain the accommodation for an indefinite period provided full payment is made unless four weeks termination of contract is given by either party to the other.
In the event of death of the Service User, any fees outstanding for Service User’s will be charged to their estate. Third parties who agree to meet Service User’s fees in whole or part must sign below to this effect before the said person becomes a Service Use
Woodrow may give notice to the Service User of termination of this agreement as outlined in clause 4 above, requiring the Service User to leave the Home under the following circumstances:
a Non-payment of fees
b If, having consulted the Service User and taken advice from the appropriate member of the primary health care team, e.g. GP, Consultant Specialist or Social Worker concerning the present and future care needs of the Service User, Woodrow are no longer able to meet theService User’s needs.
c Any circumstances or behaviour which Woodrow feel may be seriously detrimental to the Home or welfare of other Service Users.
9. Fees will be reviewed from time to time as determined by Woodrow. Any increase in the fee will be as a result of inflation, or any other increase in overheads or operating costs which Woodrow experiences for the provision of additional care and service or as a result of statutory provisions coming into force after the date hereof.
Medical and Personal Requirements:
The Service User shall from his/her own resources provide (other than medication by prescription), hairdresser, newspapers, clothing, toilet requisites, incontinent aids, other items of luxury or personal nature. Telephone calls will be charged at the current domestic rate. Private
Telephone lines can be installed into the rooms at the Residents expense.
Service Users will be required, before taking up residence, to provide information to
Woodrow on the state of their health, any treatment required and the name of the medical advisor and complete all necessary consent forms in respect therefore including Access to Medical Record Act Forms.
The Service User or, where appropriate, his or her representative may request Woodrow take charge of and dispense all the Service Users prescribed medications. If a Service User elects to retain and administer his or her own medication it must first be agreed with the Doctor and manager
Personal Effects and Personal Mobility:
13. Service Users are free to journey out alone; however, Woodrow cannot accept responsibility for a Service User’s safety away from the Home unless the journey and any necessary supervision were arranged by the Home.
14. All electrical items brought by Service Users on admission or during occupation of the Home shall be first inspected as to their safety by Woodrow before their use.
PORTABLE HEATERS MUST NOT BE BROUGHT INTO THE PROPERTY, WITHOUT P.A.T. testing and PERMISSION FROM THE MANAGER
At the discretion of Woodrow items of furniture may be brought in by the Service User subject to inspection as to condition and defects liable to render the article unsafe or unfit. Transportation insurance and eventual removal of such items shall be the Service User’s responsibility or that of the executors.
16. Woodrow is insured at the rate of £50-00………… per person for valuable effects left in the Service User’s rooms. All items over £50- 00…….. Need to be itemised, but insurance does not extend to Service User’s cash securities and other monies.
17. All valuable assets must be declared upon admission for insurance purposes. Safekeeping can be arranged at Woodrow.
In the Event of an Emergency:
The Service User is asked to supply the following information to assist the staff in the event of an emergency or termination of accommodation:
Name, address and telephone number of next of kin:
................................................................................................... ................................................................................................... ................................................................................................... ....................................
Any Social or cultural traditions that the Service User requires to keep:
Status of the Home:
Woodrow is registered as a Care Home with the Care Quality Commission
SIGNED: ………………………………………………. For and behalf of Woodrow
SIGNED: ………………………………………………. Service User DATE: ……………………………………………….
In the case of a Service User whose fees are paid in whole or part by a third party the undersigned appointee, representative or next of kin hereby agrees to pay any outstanding arrears arising up until termination of this Agreement.
SIGNED: ………………………………………………. CAPACITY: ……………………………………………….. ADDRESS: ……………………………………………….. ……………………………………………….. ………………………………………………..