10A NCAC 09 .3009 · Violation

Name of Operation: CREEKSIDE ELEMENTARY PRE-K Facility ID: 74000752 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: Visit Date: 12/3/2024 Number Present: 15 Completed Date: 12/3/2024 Age: From 4 To 5 Total Minutes: 195 Time In: 08:55 AM Time Out: 12:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit, including compliance with requirements located in Child Care Rule Section .3000 in spaces #1, where children participating in the NC Pre-K program are cared for. A. Fuller, lead teacher, assisted me with today’s visit. Your program currently operates with a five-star license, issued 3/2/20, earning 7 points in the education component, 7 points in the program standards component (meeting enhanced requirements and reduced ratios) and 1 quality point for the education option of 75% of teachers have an AAS or higher in ECE/CD, 75% of lead teachers have a BA/BS or higher in ECE/CD and all lead teachers have an AAS or higher in ECE/CD. Your program was also monitored for compliance with implementing an approved curriculum, High Scope, as required for all four and five star licensed facilities where four-year-old children are enrolled. The last annual compliance visit was conducted 1/5/24. The sanitation inspection was completed 9/25/24 with a “Superior” classification. The last fire inspection was conducted 9/16/24 and your facility was approved for daytime care only. This facility is owned by Pitt County Schools. The center's compliance history was reviewed with the operator. The program’s compliance history was ninety-eight percent as of 12/2/24. I monitored all indoor and outdoor spaces. Upon arrival the class were engaged in circle time. The teacher read the book “The Gingerbread Boy”. The class discussed the parts of the book: spine, front, back. The children transitioned to free play. I observed children building with Duplo blocks, magna tiles, decorating a tree with ornaments, pretending to cook food, and using cookie cutters with paint and paper. Teachers moved around the classroom engaging with the children. The children were given a 5-minute warning about the upcoming transition to lunch. After lunch, the class transitioned to outdoor free play. There is a stationary climbing structure, tricycles, swings, and other toys available in storage building on the outdoor learning area. Proper handwashing techniques were observed. Lunch was observed during today’s visit and included: Beef tacos or chicken quesadilla, tortilla chips, steamed corn, black beans, apple, and milk. The NC Pre-K requirements in section .3000 of the child care rules were monitored for compliance. Staff-child ratios and maximum group sizes required in Child Care Rule 10A NCAC 09 .3009 were verified in compliance. The current NC Pre-K staff are lead teacher, A. Fuller and teacher, E. Kasey. A selection of files were monitored for completed health assessments and developmental screenings. The facility meets DPI requirements for transportation. The program uses the Teaching Strategies Gold instrument to document evidence of children's ongoing progress. Checkpoint assessments are conducted three times per year: at the beginning, middle and end of the school year. The first day of school was 9-4-24. The classroom operates from 7:30 am to 2:00 pm. Parent conferences are held three times per year. You stated that you use the Class DoJo app, monthly newsletters, when children are dropped off and picked up, and phone calls to communicate with parents any information about the child’s day and any reminders. The environment rating scale score received on 4/8/24 was 5.89. The following violation was observed: Violation Number Comment Rule 1044 Prior to the expiration date of the qualification letter, the child care provider did not complete and submit required forms to complete a criminal background check (a qualification letter is valid for a maximum of five years for the date of issuance). The qualification letter for E. Kasey, Teacher Assistant expired October 8, 2024. The current Qualification Letter was issued on October 10, 2024. G.S. 110-90.2(b) & .2703(n)&(o) Compliance Verification: Violation cited during today’s visit have been corrected. No further action is required at this time. Technical Assistance: Criminal Background Checks- Criminal background checks (CBC) are completed to protect children from abuse and reduce liability risks. A CBC must be completed prior to employee hire and every five years thereafter. An expiration date is now listed on each Qualification Letter. Submissions can also be made six months before the expiration date listed on the current Qualification Letter. The qualification letter for E. Kasey, Teacher Assistant expired October 8, 2024. The current Qualification Letter was issued on October 10, 2024. Monitoring your files monthly will help you meet required deadlines. Information regarding how to complete a CBC can be found on the Division’s website, www.ncchildcare.nc.gov, under the link for “new criminal record check requirements”. Additional comments: I shared with you timelines of how long medication authorizations are valid, including emergency medications/ chronic illness, over-the-counter medications, short term prescription medications, and topical ointments. We discussed Clean Classrooms for Carolina Kids and you have completed lead-based paint, and asbestos testing and the sample kit has been shipped to the facility. Natural Learning Initiative: https://naturalearning.org/resources/ Resources are created, often in collaboration with the Natural Learning Initiative’s interdisciplinary partners, to support technical assistance, professional development, and generally to promote the importance of the natural environment in the daily experience of all children. The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me Michelle O’Kelley, Child Care Consultant, (252) 508-3955, Michelle.OKelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, (252) 373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

G.S. 110-90 · Violation

Name of Operation: CREEKSIDE ELEMENTARY PRE-K Facility ID: 74000752 Consultant: MICHELLE O'KELLEY Operation Type: Center Case Number: Visit Date: 12/3/2024 Number Present: 15 Completed Date: 12/3/2024 Age: From 4 To 5 Total Minutes: 195 Time In: 08:55 AM Time Out: 12:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit, including compliance with requirements located in Child Care Rule Section .3000 in spaces #1, where children participating in the NC Pre-K program are cared for. A. Fuller, lead teacher, assisted me with today’s visit. Your program currently operates with a five-star license, issued 3/2/20, earning 7 points in the education component, 7 points in the program standards component (meeting enhanced requirements and reduced ratios) and 1 quality point for the education option of 75% of teachers have an AAS or higher in ECE/CD, 75% of lead teachers have a BA/BS or higher in ECE/CD and all lead teachers have an AAS or higher in ECE/CD. Your program was also monitored for compliance with implementing an approved curriculum, High Scope, as required for all four and five star licensed facilities where four-year-old children are enrolled. The last annual compliance visit was conducted 1/5/24. The sanitation inspection was completed 9/25/24 with a “Superior” classification. The last fire inspection was conducted 9/16/24 and your facility was approved for daytime care only. This facility is owned by Pitt County Schools. The center's compliance history was reviewed with the operator. The program’s compliance history was ninety-eight percent as of 12/2/24. I monitored all indoor and outdoor spaces. Upon arrival the class were engaged in circle time. The teacher read the book “The Gingerbread Boy”. The class discussed the parts of the book: spine, front, back. The children transitioned to free play. I observed children building with Duplo blocks, magna tiles, decorating a tree with ornaments, pretending to cook food, and using cookie cutters with paint and paper. Teachers moved around the classroom engaging with the children. The children were given a 5-minute warning about the upcoming transition to lunch. After lunch, the class transitioned to outdoor free play. There is a stationary climbing structure, tricycles, swings, and other toys available in storage building on the outdoor learning area. Proper handwashing techniques were observed. Lunch was observed during today’s visit and included: Beef tacos or chicken quesadilla, tortilla chips, steamed corn, black beans, apple, and milk. The NC Pre-K requirements in section .3000 of the child care rules were monitored for compliance. Staff-child ratios and maximum group sizes required in Child Care Rule 10A NCAC 09 .3009 were verified in compliance. The current NC Pre-K staff are lead teacher, A. Fuller and teacher, E. Kasey. A selection of files were monitored for completed health assessments and developmental screenings. The facility meets DPI requirements for transportation. The program uses the Teaching Strategies Gold instrument to document evidence of children's ongoing progress. Checkpoint assessments are conducted three times per year: at the beginning, middle and end of the school year. The first day of school was 9-4-24. The classroom operates from 7:30 am to 2:00 pm. Parent conferences are held three times per year. You stated that you use the Class DoJo app, monthly newsletters, when children are dropped off and picked up, and phone calls to communicate with parents any information about the child’s day and any reminders. The environment rating scale score received on 4/8/24 was 5.89. The following violation was observed: Violation Number Comment Rule 1044 Prior to the expiration date of the qualification letter, the child care provider did not complete and submit required forms to complete a criminal background check (a qualification letter is valid for a maximum of five years for the date of issuance). The qualification letter for E. Kasey, Teacher Assistant expired October 8, 2024. The current Qualification Letter was issued on October 10, 2024. G.S. 110-90.2(b) & .2703(n)&(o) Compliance Verification: Violation cited during today’s visit have been corrected. No further action is required at this time. Technical Assistance: Criminal Background Checks- Criminal background checks (CBC) are completed to protect children from abuse and reduce liability risks. A CBC must be completed prior to employee hire and every five years thereafter. An expiration date is now listed on each Qualification Letter. Submissions can also be made six months before the expiration date listed on the current Qualification Letter. The qualification letter for E. Kasey, Teacher Assistant expired October 8, 2024. The current Qualification Letter was issued on October 10, 2024. Monitoring your files monthly will help you meet required deadlines. Information regarding how to complete a CBC can be found on the Division’s website, www.ncchildcare.nc.gov, under the link for “new criminal record check requirements”. Additional comments: I shared with you timelines of how long medication authorizations are valid, including emergency medications/ chronic illness, over-the-counter medications, short term prescription medications, and topical ointments. We discussed Clean Classrooms for Carolina Kids and you have completed lead-based paint, and asbestos testing and the sample kit has been shipped to the facility. Natural Learning Initiative: https://naturalearning.org/resources/ Resources are created, often in collaboration with the Natural Learning Initiative’s interdisciplinary partners, to support technical assistance, professional development, and generally to promote the importance of the natural environment in the daily experience of all children. The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at www.mppfc.org. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me Michelle O’Kelley, Child Care Consultant, (252) 508-3955, Michelle.OKelley@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, (252) 373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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 .3009 · Violation

Name of Operation: CREEKSIDE ELEMENTARY PRE-K Facility ID: 74000752 Consultant: LESHAUNDA MCCOTTER Operation Type: Center Case Number: Visit Date: 1/5/2024 Number Present: 14 Completed Date: 1/5/2024 Age: From 4 To 5 Total Minutes: 193 Time In: 08:42 AM Time Out: 11:55 AM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit, including compliance with requirements located in Child Care Rule Section .3000 in spaces #1, where children participating in the NC Pre-K program are cared for. A. Fuller, lead teacher, assisted me with today’s visit. Your program currently operates with a five-star license, issued 3/2/20, earning 7 points in the education component, 7 points in the program standards component (meeting enhanced requirements and reduced ratios) and 1 quality point for the education option of 75% of teachers have an AAS or higher in ECE/CD, 75% of lead teachers have a BA/BS or higher in ECE/CD and all lead teachers have an AAS or higher in ECE/CD. Your program was also monitored for compliance with implementing an approved curriculum, High Scope, as required for all four and five star licensed facilities where four-year-old children are enrolled. The last annual compliance visit was conducted 1/20/23. The sanitation inspection was completed 12/23/23 with a “Superior” classification. The last fire inspection was conducted 9/12/23 and your facility was approved for daytime care only. I monitored all indoor and outdoor spaces. Upon arrival the group was transitioning to outdoor free play. The outdoor learning area offered a stationary climbing structure, tricycles, hula hoops, swings, and push toys. One teacher lead a game of Simon Says as the other walked around the playground, monitoring and talking to children not participating in the game. When the group re-entered the building, they put away coats and washed hands, before reporting to whole group. The class reviewed the classroom promise and began a discussion about Winter and snow. Children shared what they knew, and the teacher added details. During indoor free play, children engaged in learning centers including blocks, dramatic play, library, manipulatives, and art. Teachers moved about the classroom engaging in conversation and play with the children. Proper hand washing techniques were observed. Lunch was observed during today’s visit and included cheese pizza, carrots, peaches, and milk. The NC Pre-K requirements in section .3000 of the child care rules were monitored for compliance. Staff-child ratios and maximum group sizes required in Child Care Rule 10A NCAC 09 .3009 were verified in compliance The current NC Pre-K staff are lead teacher, A. Fuller and teacher, E. Kacey. A selection of files were monitored for completed health assessments and developmental screenings. The classroom uses the Teaching Strategies Gold instrument to document evidence of children's ongoing progress. The checkpoint assessments are conducted three times per year: at the beginning, middle and end of the school year. Family involvement activities/events are offered throughout the school year. The first day of school was 9-5-23. The classroom operates from 7:30 am to 2:00 pm. Parent conferences are held three times per year. You stated that you use the Class DoJo app and children’s daily communication folders to communicate with parents any information about the child’s day and any reminders. The environment rating scale score received on 1/27/20 was 6.3. The following violation was observed Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. No fire drill was documented for December 2023. .0604(t); .0302(d)(5) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. On or before 1/19/23, I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Mail or email the information to: LeShaunda McCotter, Child Care Consultant P.O. Box 397 Grifton, NC 28530 LeShaunda.McCotter@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Fire Drills- Fire drills shall be practiced monthly, and records shall be maintained as required. Records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill shall be available for review. Documentation of a fire drill for December 2023 was not on file during the visit. You stated that there was not a school wide drill conducted in the month of December. Today I suggested you complete and independent drill to ensure a fire drill is practiced at least monthly. Reminders: Be knowledgeable of the child care laws and rules and environmental health rules; review them with your staff and assist them with understanding and implementing them to maintain compliance and keep children safe and healthy. The most recent versions of child care laws and rules (updated 7/1/23) and environmental health rules (updated 7/1/23) in North Carolina, the Items Number Listing (can be used as a detailed checklist of required items) and What’s New information are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. The Healthy Social Behaviors (HSB) Project supports teachers to promote healthy social-emotional development and reduce the expulsion rate among young children in licensed child care centers across North Carolina. The team is made up of specialists with early childhood education backgrounds who are passionate about empowering teachers to develop learning environments and teaching practices that promote prosocial skills in young children. To speak to a Behavior Support Advisor contact 1-888-600-1685 option 1 or to submit a question visit https://docs.google.com/forms/d/e/1FAIpQLSc-4ADUCpoHc9MrxFvD15H12AwsNWbUtWEJRXW38q_41Y3 hzA/viewform. The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at mppfc.org. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at LeShaunda McCotter, Child Care Consultant, 252-751-8634, LeShaunda.McCotter@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

NC GS 110-90 · Violation

Name of Operation: CREEKSIDE ELEMENTARY PRE-K Facility ID: 74000752 Consultant: LESHAUNDA MCCOTTER Operation Type: Center Case Number: Visit Date: 1/5/2024 Number Present: 14 Completed Date: 1/5/2024 Age: From 4 To 5 Total Minutes: 193 Time In: 08:42 AM Time Out: 11:55 AM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for an annual compliance visit, including compliance with requirements located in Child Care Rule Section .3000 in spaces #1, where children participating in the NC Pre-K program are cared for. A. Fuller, lead teacher, assisted me with today’s visit. Your program currently operates with a five-star license, issued 3/2/20, earning 7 points in the education component, 7 points in the program standards component (meeting enhanced requirements and reduced ratios) and 1 quality point for the education option of 75% of teachers have an AAS or higher in ECE/CD, 75% of lead teachers have a BA/BS or higher in ECE/CD and all lead teachers have an AAS or higher in ECE/CD. Your program was also monitored for compliance with implementing an approved curriculum, High Scope, as required for all four and five star licensed facilities where four-year-old children are enrolled. The last annual compliance visit was conducted 1/20/23. The sanitation inspection was completed 12/23/23 with a “Superior” classification. The last fire inspection was conducted 9/12/23 and your facility was approved for daytime care only. I monitored all indoor and outdoor spaces. Upon arrival the group was transitioning to outdoor free play. The outdoor learning area offered a stationary climbing structure, tricycles, hula hoops, swings, and push toys. One teacher lead a game of Simon Says as the other walked around the playground, monitoring and talking to children not participating in the game. When the group re-entered the building, they put away coats and washed hands, before reporting to whole group. The class reviewed the classroom promise and began a discussion about Winter and snow. Children shared what they knew, and the teacher added details. During indoor free play, children engaged in learning centers including blocks, dramatic play, library, manipulatives, and art. Teachers moved about the classroom engaging in conversation and play with the children. Proper hand washing techniques were observed. Lunch was observed during today’s visit and included cheese pizza, carrots, peaches, and milk. The NC Pre-K requirements in section .3000 of the child care rules were monitored for compliance. Staff-child ratios and maximum group sizes required in Child Care Rule 10A NCAC 09 .3009 were verified in compliance The current NC Pre-K staff are lead teacher, A. Fuller and teacher, E. Kacey. A selection of files were monitored for completed health assessments and developmental screenings. The classroom uses the Teaching Strategies Gold instrument to document evidence of children's ongoing progress. The checkpoint assessments are conducted three times per year: at the beginning, middle and end of the school year. Family involvement activities/events are offered throughout the school year. The first day of school was 9-5-23. The classroom operates from 7:30 am to 2:00 pm. Parent conferences are held three times per year. You stated that you use the Class DoJo app and children’s daily communication folders to communicate with parents any information about the child’s day and any reminders. The environment rating scale score received on 1/27/20 was 6.3. The following violation was observed Violation Number Comment Rule 805 Fire drills were not practiced monthly and/or the drill record was incomplete. No fire drill was documented for December 2023. .0604(t); .0302(d)(5) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. On or before 1/19/23, I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Mail or email the information to: LeShaunda McCotter, Child Care Consultant P.O. Box 397 Grifton, NC 28530 LeShaunda.McCotter@dhhs.nc.gov If you email the compliance letter, it must be sent from the email address registered with the DCDEE (this serves as your signature) and the following information must be included: name, position, facility name, and facility ID number. An example is: Jane Doe, Administrator AAA Child Care ID # 12345678 Technical Assistance: Fire Drills- Fire drills shall be practiced monthly, and records shall be maintained as required. Records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill shall be available for review. Documentation of a fire drill for December 2023 was not on file during the visit. You stated that there was not a school wide drill conducted in the month of December. Today I suggested you complete and independent drill to ensure a fire drill is practiced at least monthly. Reminders: Be knowledgeable of the child care laws and rules and environmental health rules; review them with your staff and assist them with understanding and implementing them to maintain compliance and keep children safe and healthy. The most recent versions of child care laws and rules (updated 7/1/23) and environmental health rules (updated 7/1/23) in North Carolina, the Items Number Listing (can be used as a detailed checklist of required items) and What’s New information are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. The Healthy Social Behaviors (HSB) Project supports teachers to promote healthy social-emotional development and reduce the expulsion rate among young children in licensed child care centers across North Carolina. The team is made up of specialists with early childhood education backgrounds who are passionate about empowering teachers to develop learning environments and teaching practices that promote prosocial skills in young children. To speak to a Behavior Support Advisor contact 1-888-600-1685 option 1 or to submit a question visit https://docs.google.com/forms/d/e/1FAIpQLSc-4ADUCpoHc9MrxFvD15H12AwsNWbUtWEJRXW38q_41Y3 hzA/viewform. The Martin-Pitt Partnership for Children is able to provide you with resources and information, training opportunities, technical assistance on child care issues, and assistance with the Environment Rating Scales. Their phone number is (252) 758-8885 or check out their website at mppfc.org. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at LeShaunda McCotter, Child Care Consultant, 252-751-8634, LeShaunda.McCotter@dhhs.nc.gov or Jennifer Linhardt, Licensing Supervisor, 252-373-4199, Jennifer.Linhardt@dhhs.nc.gov if you have questions. 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