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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403312
Report Date: 06/12/2026
Date Signed: 06/16/2026 10:13:38 AM

Document Has Been Signed on 06/16/2026 10:13 AM - 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:MAYORGA FAMILY DAY CAREFACILITY NUMBER:
197403312
ADMINISTRATOR/
DIRECTOR:		C. & C. MAYORGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 846-8100
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
06/12/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Carlos & Concepcion Mayorga, LicenseesTIME VISIT/
INSPECTION COMPLETED:
11:55 AM
NARRATIVE
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On 06/12/2026, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Required 3-Year inspection at 2136 N. Buena Vista Street, Burbank, CA. 91504. LPA arrived at the facility at 08:45 AM, identified self and met with Concepcion and Carlos Mayorga, Licensees, who guided analyst on a tour of the inside and outside of the facility. There were two (2) children present at arrival. LPA provided Licensee with a copy of the LIC126 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Friday from 7:00AM to 06:00PM.

The family child care home is a one-story dwelling with a living room, dining room, combination den/kitchen, four (4) bedrooms, two (2) bathrooms, and detached garage. There are an unfenced front yard and a fenced backyard. During the tour, LPA observed that the combination den/kitchen is undergoing a refresh of the existing room. Per Licensees, the refresh of the space includes new cabinets and floors. LPA obtained an updated facility sketch to include the living room as day care area and the den/kitchen and back yard are off limits until the refresh is completed. A California Code of Regulations, Type B citation for section 102416.3(a) Alterations to Existing Building and Grounds was issued.

The children enter the facility from the front door.

LPA observed, the living room is used for play activities, eating and sleeping and there are chairs, tables, cots, and play yards that are safe, clean, and appropriate for the age of the children. LPA observed cots for napping and bed linens that are provided by the Licensee. LPA observed that personal items are kept in bags and diapers are kept in individual bins. LPA observed the children have access to bathroom #2 located
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/16/2026 10:13 AM - It Cannot Be Edited


Created By: Elicia Calvillo On 06/12/2026 at 10:17 AM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MAYORGA FAMILY DAY CARE
FACILITY NUMBER: 197403312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that both Licensees Mandated Reporter certification of completion was not available upon request which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
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Licensess stated that they will complete the Mandated Reporter Training by the plan of correction due date 06/19/2026 and email LPA a copy of the certficate.
Type B
Section Cited
CCR
102416.3(a)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that Licenees did not notify the Department prior to refreshing the den/kitchen area which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee cleared citation by providing LPA with an updated facility sketch and their child care plan during the refresh period.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2026


LIC809 (FAS) - (06/04)
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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: MAYORGA FAMILY DAY CARE
FACILITY NUMBER: 197403312
VISIT DATE: 06/12/2026
NARRATIVE
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in the hallway near the living room. LPA observed a pedestal sink and no vanity cabinet, the bathroom used by children was safe, sanitary and no hazards were present. The outdoor play is not available for children during the den/kitchen refresh and LPA obtained a updated facility sketch.

LPA reminded Licensee that children are to be supervised at all times when they are in the front yard. LPA advised Licensee that children shall not be left in parked vehicles and car seats are used for transportation purposes only and are not used for sleeping children.

Licensee stated that when a child shows signs of an illness the child will be isolated in the living room, away from the other children until their parents arrive.

The areas in the family child care home that are off limits to parents and children are the den/kitchen room, dining room, four (4) bedrooms, one (1) bathroom, back yard, and detached garage. These rooms are made inaccessible by using door locks to those rooms.

There is a smoke detector located in walkway near the dining room and carbon monoxide detector located in the dining room and both were tested and are operable. There is a working fire extinguisher, the valve on the required 2A:10BC fire extinguisher indicates fully charged and the service date was 10/10/2025. LPA did not observe a fireplace or any open-faced heater. There are adequate heating and ventilation for safety and comfort. An emergency fire/disaster drill has not been completed within the last 6 months, and the documentation of the fire/disaster drill was readily available upon request showed last fire/disaster drill completed 05/29/2026. There is telephone service via a cellphone, LPA reminded Licensee that the cellphone must remain in the facility during the hours of operation.

LPA did not observe a swimming pool or other similar bodies of water.

Licenses stated the is a cat on premises and during the hours of operations stays in the bedroom areas.

Per Licensee, there are no firearms or ammunition or other weapons on the premises. LPA did not observe any firearms or other weapons on the premises. Per Licensee, there are no poisons on the premises, LPA

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
LIC809 (FAS) - (06/04)
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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: MAYORGA FAMILY DAY CARE
FACILITY NUMBER: 197403312
VISIT DATE: 06/12/2026
NARRATIVE
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 did not observe any poison on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

Capacity as specified on the license is being maintained.

LPA reviewed samples of children’s records and observed records are complete and documented on the LIC857. LPA observed Licensee records and observed records are not complete and document on the LIC859. Licensee’s Mandated Reporter Training has expired and a Health and Safety Code Type B citation for section 1596.8662(b)(1) Administration of Child Day Care Licensing was issued. Licensee’s Pediatric CPR/First Aid was expired.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Licensees were reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

There is currently one (1) infant enrolled at the facility. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: MAYORGA FAMILY DAY CARE
FACILITY NUMBER: 197403312
VISIT DATE: 06/12/2026
NARRATIVE
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During the exit interview, the Concepcion and Carlos Mayorga, Licensees, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During today's inspection, there were two (2) Type B citations for sections 102416.3(a) Alterations to Existing Building and Grounds and section 1596.8662(b)(1) Administration of Child Day Care Licensing.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Concepcion and Carlos Mayorga, Licensees.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
LIC809 (FAS) - (06/04)
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