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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420586
Report Date: 02/07/2023
Date Signed: 02/07/2023 03:27:07 PM

Document Has Been Signed on 02/07/2023 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:THROUGH THE LOOKING GLASS EARLY HEAD STARTFACILITY NUMBER:
013420586
ADMINISTRATOR:CATCHING, DENISEFACILITY TYPE:
850
ADDRESS:3075 ADELINE AVENUETELEPHONE:
(510) 393-6824
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Malika GuergahTIME COMPLETED:
03:35 PM
NARRATIVE
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On February 7, 2023 Licensing Program Analyst (LPA) Indira Loza arrived at the facility to conduct a case management visit as a direct result to an Unusual Incident report received in our office. Present for the visit were the Director Denice Cathching & Co-Director Malika Guergah, four preschool-aged children, and one additional fingerprint cleared staff.

Based on interviews conducted, our office has determined that a staff unbuckled a child from their wheelchair and immediately left the child unsupervised allowing the child to lean forward and fall off the wheelchair, causing them to have serious injuries. This is a Type A violation of section 101229(a)(1).

One Type A deficiency is being cited during today's inspection. The Licensee must provide a copy of this report to all parents of children currently enrolled, and the parents of newly enrolled children in the next 12 months. In addition, Form LIC 9224 (Acknowledgment of receipt of Licensing Reports) must be signed by each parent and placed in each child's file.

A copy of the LIC 9224 is being provided.

Exit Interview conducted and Appeal Rights provided to Director Denice Cathching & Co-Director Malika Guergah.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/07/2023 03:27 PM - It Cannot Be Edited


Created By: Indira Loza On 02/07/2023 at 02:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: THROUGH THE LOOKING GLASS EARLY HEAD START
FACILITY NUMBER: 013420586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision : (a)The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections
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Director shall email the LPA a plan for preventing this type of incident from occuring no later than Febrary 8, 2023.
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101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: A child fell from their wheelchair as a result from staff not supervising the child. The child also sustained serious injuries.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


LIC809 (FAS) - (06/04)
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