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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191209401
Report Date: 09/15/2022
Date Signed: 09/15/2022 01:37:59 PM


Document Has Been Signed on 09/15/2022 01:37 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:ZSIGMOND FAMILY DAY CAREFACILITY NUMBER:
191209401
ADMINISTRATOR:EDITH ZSIGMONDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 554-8813
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:12CENSUS: 5DATE:
09/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:EDITH ZSIGMONDTIME COMPLETED:
01:55 PM
NARRATIVE
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On 09/15/2022, Licensing Program Analyst (LPA) Loyce Phillips made an unannounced visit for the purpose of conducting a Case Management-Deficiencies visit. LPA met with Licensee, Edith Zsigmond and observed 5 children in care.

The visit is due to the Department being made aware that Licensee has an assistant, Rosa Martinez working in the facility without a Criminal Record Clearance, which is cited with a Civil Penalty.

The licensee is also being cited for not having an updated facility roster and for not reporting to the Department via incident reports when local law enforcement was called to the facility.

Type A citation is being issued and civil penalty is being assessed. See LIC809D.


The Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

In addition, a copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months. The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

An exit interview was conducted with Licensee, Edith Zsigmond. A copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: 424-301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 09/15/2022 01:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: ZSIGMOND FAMILY DAY CARE
FACILITY NUMBER: 191209401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/15/2022
Section Cited

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102370(d)(1) Criminal Record Clearance (d)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Department
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Based on interviews conducted and observations, Assistant was working in the facility without a criminal record clearance, which poses an immediate health, safety or personal rights risk to persons in care.
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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: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: 424-301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 09/15/2022 01:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: ZSIGMOND FAMILY DAY CARE
FACILITY NUMBER: 191209401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2022
Section Cited

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1596.841Current roster of children provided care in facility required. Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone numbers....
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This requirement was not met as evidence by: Based on record review, Licensee did not have a current roster. This poses a potential health and safety risk to children in care.
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Type B
09/29/2022
Section Cited

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102416.2(b)Reporting Requirements. (b)The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.....
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This requirement was not met as evidenced by: Licensee failed to notify the Department when local law enforcement was called to the facility. This poses a potential health and safety risk to children in care.
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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: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: 424-301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3