Creative Minds Child Care

10A NCAC 09 .1705 · Violation

Name of Operation: CREATIVE MINDS CHILD CARE Facility ID: 41000890 Consultant: SAMANTHA MCLEOD Operation Type: Family CC Home Case Number: Visit Date: 7/24/2025 Number Present: 3 Completed Date: 7/24/2025 Age: From 2 To 9 Total Minutes: 120 Time In: 01:30 PM Time Out: 03:30 PM Time In: Time Out: List to Use: Family CC Home Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor for compliance during an annual compliance visit. A checklist was used to note the requirements I monitored today. This Family Child Care Home (FCCH) currently operates with a Four Star license reissued on July 27, 2017. Upon arrival to the FCCH, I was greeted by the owner and operator Mrs. Elaine Leath. Mrs. Leath assisted me during my visit today. Three (3) children were present during today’s visit. During today’s visit the children were observed resting on mats in the primary space. All enrolled children's files were monitored as well as the providers’ record, which was monitored for compliance. All indoor and outdoor spaces used by the children was observed today. Monthly fire drills and playground inspections have been documented as well as quarterly disaster drills. To verify compliance with specific requirements, you were given a Verification of Required Information for Operator and Additional Caregivers form and FCCH and Centers Located in a Residence Operator’s Statements of Responsibility form to complete. I received the signed forms during today’s visit. Your signature on these forms will serve as verification the information provided is accurate and complete. Required background checks for all household members are current, please refer to the verification form for additional information. Today the following violations of child care requirements were cited today. Violation Number Comment Rule 701 All indoor and outdoor areas used by the children were not kept clean, orderly, and free of items which are potentially hazardous to children including removal of items a child can swallow; the removal of loose nails or screws and splinters on inside; and use of outdoor equipment that is too hot to touch. There was high grass observed in the outdoor play space which poses a hazard to the children. .1719(a)(1)&(17) 1101 Operator or other transportation provider did not have written permission from each child's parents or guardian to transport the child. The provider did not obtain "written" permission to transport children on a field trip on 7/24/2025. The provider stated she had given the parents a verbal notification. .1723(5) 1301 Operator did not complete the required number of on-going training hours as specified in rule. The provider had not completed the required number of training hours; she was short 8 hours for 2025. GS 110-91(11); 10A NCAC 09 .1705(b)(5) Child Care facilities must maintain compliance with applicable childcare requirements at all times. In order to maintain compliance with North Carolina childcare laws and rules, the above violation must be corrected immediately. Please send a letter of compliance stating how the above violation was corrected and what you will do in the future to prevent this violation from being cited. Please email me this letter by August 7, 2025. CONSULTATION AND RESOURCES: --As a reminder you CPR/First Aid training needs to be updated by August 2, 2025 (Please send me a copy of your completion certificated) --Also you and your husband criminal background check, (CBC) will need to be updated by October 28, 2025. ANNUAL TRAINING: --You stated that you would like to complete your training by July 31st of each year. --You are required to complete 10 hours of training annually. --As a reminder you can carry over half of what you are required to complete each year to the next year -- Please make sure you have copies of all completed training available for review and documented on the “In-service” training log. --Health & Safety training & Child Maltreatment training is required once every 5years. ANNUAL REMINDERS: --The Written Plan of Care must be updated annually as well as the children’s emergency information. You stated today that you would complete these updates by August 31st of each year. --An updated Health Questionnaire (provider) is to also be completed. You stated you would up this document by July 31st of each year. TRANSPORTATION REQUIREMENTS: During today’s visit I reviewed transportation requirements with you. Transporting children in childcare is a huge responsibility and a high-risk activity. Transportation of children must be taken seriously. Transporting children requires careful planning and proactive, protective measures to ensure the safety of children and staff. Any time children are transported there is the potential for problems to occur. Careful planning reduces the risk of harm or injury to children and reduces liability for childcare operators and their programs. It is necessary for the safety of children to require the caregiver to comply with all applicable state and federal laws and regulations concerning vehicles and the transportation of passengers. --Each child transported must have emergency contact information on file along with a photograph of each child. This is helpful in identifying children in the event of an emergency/accident. The child’s parent/guardian must also give written permission for their child to be transported and must be aware of the time and location. --All vehicles must be free of hazards to include potentially hazardous products. The same requirements for products inside the facility apply to the vehicles used to transport children. The vehicles should be cleaned out, organized, and prepared to transport children on the vehicle. Additional Reminders: --Parents must give written permission for each field trip. --Children may never be left unattended on the vehicle. -- Each child being transported must have identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care -- First Aid kit and fire extinguisher must be located in each vehicle used to transport children. --Children cannot occupy the front seat and must use an individual seat belt or safety seat appropriate for the age and weight. --You must have a current drivers license, registration and car insurance. --You must follow all state and local driving laws. **For a complete explanation of these rules please refer to the Family Child Care requirements section .1723 RECORD RETENTION: Record Retention is important for child care programs not only to keep good records, but also to know which ones to retain and for how long. During today’s visit we discussed how long program records must be kept on file. I will email you a chart to use a reference guide for maintaining required documents. CLEAN CLASSROOMS FOR CAROLINA KIDS: Lead and asbestos testing are mandated and required for facilities. You are required to meet rule requirements (NC 10A NCAC 41C.1001-1007, NC 154A NCAC 18A.2816). All facilities with a child care license are required to complete this process. If you have not begun the steps and completed the process, I encourage you to do so as soon as possible. Due to the recent impacts of Hurricane Helene and other natural disasters, the Clean Classrooms for Carolina Kids enrollment deadline has been revised statewide, and schools and child care facilities that have not yet enrolled should complete the online process by May 31, 2025. Enroll now at: https://www.cleanwaterforcarolinakids.org/enroll The lead-based paint and asbestos enrollment surveys must be completed for ALL schools and childcare facilities within school districts prior to receiving on-site inspections. As this is a legislatively mandated effort, facilities are required to meet rule requirements (NC 10A NCAC 41C.1001-1007, NC 154A NCAC 18A.2816). Clean Classrooms for Carolina Kids™ is designed to ensure facilities meet all requirements, receive direct support throughout the participation process, and have access to communication resources. This program is free, covers testing, inspections, and mitigation, and is intended to improve child-occupied facilities across North Carolina. Some programs have only completed the process for lead testing in water. Testing includes lead in water, lead based paint, and asbestos. You should complete the online process for all 3 by May 31, 2025. In addition, testing should also be completed every three years for childcare centers. You can check your facility status: https://data.cleanwaterforuskids.org/data/north-carolina --Following today’s visit, I will send you an email which gives detailed steps on how to complete this process. RATED LICENSE UPDATE: The Governor signed Senate Bill 425 (now Session Law 2024-34), Health and Human Services Omnibus Bill, which includes the Quality Rating Improvement System (QRIS) Modifications recommended to the Legislature by the NC Child Care Commission to update QRIS and create additional pathways for licensed child care facilities to earn star rated licenses. Hold Harmless provisions have been extended and star rated license assessments for licensed child care providers will be conducted by provider request only, until the QRIS rulemaking process has been completed. Star rated license assessments are still required for new child care programs. DCDEE WEBSITE/UPDATED RULES: For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ You were provided an opportunity to ask questions regarding interpretation and implementation of all child care requirements. We appreciate all you are doing to serve the children and families of NC. If you have any further questions or concerns, please contact me at: Samantha R. McLeod Child Care Consultant (336) 580-5363 (336) 559-3513 (fax) samantha.mcleod@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: CREATIVE MINDS CHILD CARE Facility ID: 41000890 Consultant: SAMANTHA MCLEOD Operation Type: Family CC Home Case Number: Visit Date: 7/24/2025 Number Present: 3 Completed Date: 7/24/2025 Age: From 2 To 9 Total Minutes: 120 Time In: 01:30 PM Time Out: 03:30 PM Time In: Time Out: List to Use: Family CC Home Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor for compliance during an annual compliance visit. A checklist was used to note the requirements I monitored today. This Family Child Care Home (FCCH) currently operates with a Four Star license reissued on July 27, 2017. Upon arrival to the FCCH, I was greeted by the owner and operator Mrs. Elaine Leath. Mrs. Leath assisted me during my visit today. Three (3) children were present during today’s visit. During today’s visit the children were observed resting on mats in the primary space. All enrolled children's files were monitored as well as the providers’ record, which was monitored for compliance. All indoor and outdoor spaces used by the children was observed today. Monthly fire drills and playground inspections have been documented as well as quarterly disaster drills. To verify compliance with specific requirements, you were given a Verification of Required Information for Operator and Additional Caregivers form and FCCH and Centers Located in a Residence Operator’s Statements of Responsibility form to complete. I received the signed forms during today’s visit. Your signature on these forms will serve as verification the information provided is accurate and complete. Required background checks for all household members are current, please refer to the verification form for additional information. Today the following violations of child care requirements were cited today. Violation Number Comment Rule 701 All indoor and outdoor areas used by the children were not kept clean, orderly, and free of items which are potentially hazardous to children including removal of items a child can swallow; the removal of loose nails or screws and splinters on inside; and use of outdoor equipment that is too hot to touch. There was high grass observed in the outdoor play space which poses a hazard to the children. .1719(a)(1)&(17) 1101 Operator or other transportation provider did not have written permission from each child's parents or guardian to transport the child. The provider did not obtain "written" permission to transport children on a field trip on 7/24/2025. The provider stated she had given the parents a verbal notification. .1723(5) 1301 Operator did not complete the required number of on-going training hours as specified in rule. The provider had not completed the required number of training hours; she was short 8 hours for 2025. GS 110-91(11); 10A NCAC 09 .1705(b)(5) Child Care facilities must maintain compliance with applicable childcare requirements at all times. In order to maintain compliance with North Carolina childcare laws and rules, the above violation must be corrected immediately. Please send a letter of compliance stating how the above violation was corrected and what you will do in the future to prevent this violation from being cited. Please email me this letter by August 7, 2025. CONSULTATION AND RESOURCES: --As a reminder you CPR/First Aid training needs to be updated by August 2, 2025 (Please send me a copy of your completion certificated) --Also you and your husband criminal background check, (CBC) will need to be updated by October 28, 2025. ANNUAL TRAINING: --You stated that you would like to complete your training by July 31st of each year. --You are required to complete 10 hours of training annually. --As a reminder you can carry over half of what you are required to complete each year to the next year -- Please make sure you have copies of all completed training available for review and documented on the “In-service” training log. --Health & Safety training & Child Maltreatment training is required once every 5years. ANNUAL REMINDERS: --The Written Plan of Care must be updated annually as well as the children’s emergency information. You stated today that you would complete these updates by August 31st of each year. --An updated Health Questionnaire (provider) is to also be completed. You stated you would up this document by July 31st of each year. TRANSPORTATION REQUIREMENTS: During today’s visit I reviewed transportation requirements with you. Transporting children in childcare is a huge responsibility and a high-risk activity. Transportation of children must be taken seriously. Transporting children requires careful planning and proactive, protective measures to ensure the safety of children and staff. Any time children are transported there is the potential for problems to occur. Careful planning reduces the risk of harm or injury to children and reduces liability for childcare operators and their programs. It is necessary for the safety of children to require the caregiver to comply with all applicable state and federal laws and regulations concerning vehicles and the transportation of passengers. --Each child transported must have emergency contact information on file along with a photograph of each child. This is helpful in identifying children in the event of an emergency/accident. The child’s parent/guardian must also give written permission for their child to be transported and must be aware of the time and location. --All vehicles must be free of hazards to include potentially hazardous products. The same requirements for products inside the facility apply to the vehicles used to transport children. The vehicles should be cleaned out, organized, and prepared to transport children on the vehicle. Additional Reminders: --Parents must give written permission for each field trip. --Children may never be left unattended on the vehicle. -- Each child being transported must have identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care -- First Aid kit and fire extinguisher must be located in each vehicle used to transport children. --Children cannot occupy the front seat and must use an individual seat belt or safety seat appropriate for the age and weight. --You must have a current drivers license, registration and car insurance. --You must follow all state and local driving laws. **For a complete explanation of these rules please refer to the Family Child Care requirements section .1723 RECORD RETENTION: Record Retention is important for child care programs not only to keep good records, but also to know which ones to retain and for how long. During today’s visit we discussed how long program records must be kept on file. I will email you a chart to use a reference guide for maintaining required documents. CLEAN CLASSROOMS FOR CAROLINA KIDS: Lead and asbestos testing are mandated and required for facilities. You are required to meet rule requirements (NC 10A NCAC 41C.1001-1007, NC 154A NCAC 18A.2816). All facilities with a child care license are required to complete this process. If you have not begun the steps and completed the process, I encourage you to do so as soon as possible. Due to the recent impacts of Hurricane Helene and other natural disasters, the Clean Classrooms for Carolina Kids enrollment deadline has been revised statewide, and schools and child care facilities that have not yet enrolled should complete the online process by May 31, 2025. Enroll now at: https://www.cleanwaterforcarolinakids.org/enroll The lead-based paint and asbestos enrollment surveys must be completed for ALL schools and childcare facilities within school districts prior to receiving on-site inspections. As this is a legislatively mandated effort, facilities are required to meet rule requirements (NC 10A NCAC 41C.1001-1007, NC 154A NCAC 18A.2816). Clean Classrooms for Carolina Kids™ is designed to ensure facilities meet all requirements, receive direct support throughout the participation process, and have access to communication resources. This program is free, covers testing, inspections, and mitigation, and is intended to improve child-occupied facilities across North Carolina. Some programs have only completed the process for lead testing in water. Testing includes lead in water, lead based paint, and asbestos. You should complete the online process for all 3 by May 31, 2025. In addition, testing should also be completed every three years for childcare centers. You can check your facility status: https://data.cleanwaterforuskids.org/data/north-carolina --Following today’s visit, I will send you an email which gives detailed steps on how to complete this process. RATED LICENSE UPDATE: The Governor signed Senate Bill 425 (now Session Law 2024-34), Health and Human Services Omnibus Bill, which includes the Quality Rating Improvement System (QRIS) Modifications recommended to the Legislature by the NC Child Care Commission to update QRIS and create additional pathways for licensed child care facilities to earn star rated licenses. Hold Harmless provisions have been extended and star rated license assessments for licensed child care providers will be conducted by provider request only, until the QRIS rulemaking process has been completed. Star rated license assessments are still required for new child care programs. DCDEE WEBSITE/UPDATED RULES: For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ You were provided an opportunity to ask questions regarding interpretation and implementation of all child care requirements. We appreciate all you are doing to serve the children and families of NC. If you have any further questions or concerns, please contact me at: Samantha R. McLeod Child Care Consultant (336) 580-5363 (336) 559-3513 (fax) samantha.mcleod@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.1721 · Violation

Name of Operation: CREATIVE MINDS CHILD CARE Facility ID: 41000890 Consultant: CAMILLE DAVIS Operation Type: Family CC Home Case Number: Visit Date: 8/3/2023 Number Present: 3 Completed Date: 8/3/2023 Age: From 2 To 6 Total Minutes: 105 Time In: 09:55 AM Time Out: 11:40 AM Time In: Time Out: List to Use: Family CC Home Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s annual compliance visit was to assess compliance with applicable child care requirements. This family child care home (FCCH) currently operates with a Four Star license, effective July 27, 2017. Upon my arrival, today I was greeted by you, (Hattie) Elaine Leath, owner and operator of the FCCH. You told me that a fire inspection is scheduled to be completed, Friday, August 5, 2023. You will send me the completed fire inspection report after the fire inspection is conducted. I completed a walk-through of the areas of the residence used for child care including the outdoor area. Three children were present today. When I arrived, the children were engaged in free choice center play and interacting with you. Later I observed the children playing with available toys and participating in activities at the table. A full assessment of applicable child care requirements was conducted during today’s visit as per the attached checklist. The following violations were observed and documented. Violation Number Comment Rule 508 Operator did not successfully complete a first aid course as referenced in Rule.1702(b)(2) First aid training was not renewed on or before the expiration of the certification. The operator did not have current first aid training. .1703(a)(2) 511 Operator did not successfully complete a CPR course as referenced in Rule.1702(b)(2) CPR training was not renewed on or before the expiration of the certification. The operator did not have current CPR training. .1703(a)(3) 905 Record of monthly fire drills, giving the date, time of day and length of time to evacuate, and operator's signature, were not available. A fire drill was not conducted and recorded for July 2023. .1721 (e )(2) 910 Copy of each child's health assessment, including the operator's own preschool child(ren), was not on file within 30 days of enrollment. Two children's files did not have the required health assessment. GS 110-91(1); 10A NCAC 09.1721(a)(1) 921 Operator did not maintain accurate daily attendance records including documentation of arrival and departure for all children in care, including the operator's own preschool children. Daily attendance records were not completed for March 2023 to August 3, 2023. .1721(e)(6) 2023 Operator and/or staff who work with children, did not complete health and safety training as part of on-going training so that every five years, all the topic areas were covered. The operator did not complete the renewal of the health and safety training every five years as required. .1703(d)(2) 2030 Operator did not provide a written statement to parents regarding the smoking and tobacco restriction. Two children's files did not have the parent's signed statement for the receipt of the smoking and tobacco restriction policy. .1719(a)(11) 2031 Operator did not provide a copy of the shaken baby syndrome and abusive head trauma policy to parents at time of enrollment, and / or within fourteen days of a changes to the policy. Two children's files did not have the parent's signed statement for the receipt of the shaken baby syndrome and abusive head trauma policy. .1726(b)&(c) In order to maintain compliance with North Carolina child care laws and rules, the above violations must be corrected immediately. A letter stating how the violations were corrected and how you plan to maintain compliance in the future must be submitted electronically to my email address by August 17, 2023. The compliance letter should contain the following information: 1. Facility Name 2. Facility ID 3. Date of the letter 4. The violation number, the date the violation was corrected, information regarding how the violation was corrected and how you plan to maintain compliance with the item number in the future. 5. Signature of the person preparing the letter. Self-Study for Rated License Program Standards We discussed that this FCCH is in Cohort 1 of the new Rated License process and that the reassessment year for Cohort 1 will begin July 1, 2024. Throughout the next few months, I recommended you consider topics for the three-month self-study for the reassessment year, which will be sometime between July 1, 2024, and June 30, 2025. The three-month self-study is required as part of the Rated License process to earn two points in Program Standards. I recommended visiting the Rated License Assessment website at https://ncrlap.org to get some ideas about a topic or area that you want to work on for the self-study. You will contact me after you have chosen what topic you will work on for the self-study. I will review the topic with you, and we can discuss ideas for carrying out your plan. If possible, we will align the reassessment with your Annual Compliance visit timeframe. If you have any questions or if I may be of further assistance, please contact me at 336-580-7335 or by email at Camille.Davis@dhhs.nc.gov. Thank you for your time and cooperation during the visit today. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: CREATIVE MINDS CHILD CARE Facility ID: 41000890 Consultant: CAMILLE DAVIS Operation Type: Family CC Home Case Number: Visit Date: 8/3/2023 Number Present: 3 Completed Date: 8/3/2023 Age: From 2 To 6 Total Minutes: 105 Time In: 09:55 AM Time Out: 11:40 AM Time In: Time Out: List to Use: Family CC Home Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s annual compliance visit was to assess compliance with applicable child care requirements. This family child care home (FCCH) currently operates with a Four Star license, effective July 27, 2017. Upon my arrival, today I was greeted by you, (Hattie) Elaine Leath, owner and operator of the FCCH. You told me that a fire inspection is scheduled to be completed, Friday, August 5, 2023. You will send me the completed fire inspection report after the fire inspection is conducted. I completed a walk-through of the areas of the residence used for child care including the outdoor area. Three children were present today. When I arrived, the children were engaged in free choice center play and interacting with you. Later I observed the children playing with available toys and participating in activities at the table. A full assessment of applicable child care requirements was conducted during today’s visit as per the attached checklist. The following violations were observed and documented. Violation Number Comment Rule 508 Operator did not successfully complete a first aid course as referenced in Rule.1702(b)(2) First aid training was not renewed on or before the expiration of the certification. The operator did not have current first aid training. .1703(a)(2) 511 Operator did not successfully complete a CPR course as referenced in Rule.1702(b)(2) CPR training was not renewed on or before the expiration of the certification. The operator did not have current CPR training. .1703(a)(3) 905 Record of monthly fire drills, giving the date, time of day and length of time to evacuate, and operator's signature, were not available. A fire drill was not conducted and recorded for July 2023. .1721 (e )(2) 910 Copy of each child's health assessment, including the operator's own preschool child(ren), was not on file within 30 days of enrollment. Two children's files did not have the required health assessment. GS 110-91(1); 10A NCAC 09.1721(a)(1) 921 Operator did not maintain accurate daily attendance records including documentation of arrival and departure for all children in care, including the operator's own preschool children. Daily attendance records were not completed for March 2023 to August 3, 2023. .1721(e)(6) 2023 Operator and/or staff who work with children, did not complete health and safety training as part of on-going training so that every five years, all the topic areas were covered. The operator did not complete the renewal of the health and safety training every five years as required. .1703(d)(2) 2030 Operator did not provide a written statement to parents regarding the smoking and tobacco restriction. Two children's files did not have the parent's signed statement for the receipt of the smoking and tobacco restriction policy. .1719(a)(11) 2031 Operator did not provide a copy of the shaken baby syndrome and abusive head trauma policy to parents at time of enrollment, and / or within fourteen days of a changes to the policy. Two children's files did not have the parent's signed statement for the receipt of the shaken baby syndrome and abusive head trauma policy. .1726(b)&(c) In order to maintain compliance with North Carolina child care laws and rules, the above violations must be corrected immediately. A letter stating how the violations were corrected and how you plan to maintain compliance in the future must be submitted electronically to my email address by August 17, 2023. The compliance letter should contain the following information: 1. Facility Name 2. Facility ID 3. Date of the letter 4. The violation number, the date the violation was corrected, information regarding how the violation was corrected and how you plan to maintain compliance with the item number in the future. 5. Signature of the person preparing the letter. Self-Study for Rated License Program Standards We discussed that this FCCH is in Cohort 1 of the new Rated License process and that the reassessment year for Cohort 1 will begin July 1, 2024. Throughout the next few months, I recommended you consider topics for the three-month self-study for the reassessment year, which will be sometime between July 1, 2024, and June 30, 2025. The three-month self-study is required as part of the Rated License process to earn two points in Program Standards. I recommended visiting the Rated License Assessment website at https://ncrlap.org to get some ideas about a topic or area that you want to work on for the self-study. You will contact me after you have chosen what topic you will work on for the self-study. I will review the topic with you, and we can discuss ideas for carrying out your plan. If possible, we will align the reassessment with your Annual Compliance visit timeframe. If you have any questions or if I may be of further assistance, please contact me at 336-580-7335 or by email at Camille.Davis@dhhs.nc.gov. Thank you for your time and cooperation during the visit today. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times