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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376626506
Report Date: 12/09/2025
Date Signed: 04/28/2026 01:33:13 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2025 and conducted by Evaluator Mahjoba Mohsini
COMPLAINT CONTROL NUMBER: 51-CC-20250911114738
FACILITY NAME:MASSOUDI, MAHTAB FAMILY CHILD CAREFACILITY NUMBER:
376626506
ADMINISTRATOR:MAHTAB MASSOUDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 705-7577
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY:14CENSUS: 8DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Mahtab MassoudiTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Infant sustained injuries due to an unknown cause.
INVESTIGATION FINDINGS:
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THIS IS AN AMENDED REPORT DELIVERED ON 4/28/26
On 12/8/25 @ 3:10 PM, Licensing Program Analyst (LPA) Mahjoba Mohsini conducted an unannounced complaint visit for the complaint received on 9/11/25 for the purpose of delivering findings on the above referenced allegation. LPA was greeted by Licensee Mahtab Massoudi and was granted entry upon showing identification badge. LPA observed Kourosh Abram (facility assistant), and 8 day care children.

During the investigation, LPA conducted interviews with staff, third parties, reviewed available records and made observations of the facility. Information obtained and reviewed confirms C1 sustained injuries during program hours while in care. Interviews revealed conflicting staff accounts of supervision and locations prior to the incident, failing to demonstrate required visual supervision was maintained. Although staff denied a lack of supervision, the information gathered did not support that continuous and appropriate supervision was provided when the injury occurred.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keturah Lane
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 51-CC-20250911114738
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MASSOUDI, MAHTAB FAMILY CHILD CARE
FACILITY NUMBER: 376626506
VISIT DATE: 12/09/2025
NARRATIVE
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THIS IS AN AMENDED REPORT DELIVERED ON 4/28/26.

Based on the evidence obtained, the preponderance of evidence standard has been met, and the allegation is substantiated. At this time, we are reopening the investigation to allow for the receipt and subsequent review of reports from outside agencies.

Deficiencies were cited. (See LIC9099-D)

LPA Mohsini informed licensee Mahtab Massoudi that report dated 12/9/25 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPA Mohsini informed the licensee to provide a copy of the report date 12/9/25 that documents any Type A citation to parents/guardians of all children currently enrolled by next business day or the next day children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed acknowledgement of receipt of Licensing Report (LIC 9224), or other written statements, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Licensee Mahtab Massoudi. Notice of Site Visit and Appeals Rights were provided. Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Keturah Lane
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 51-CC-20250911114738
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MASSOUDI, MAHTAB FAMILY CHILD CARE
FACILITY NUMBER: 376626506
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/10/2025
Section Cited
CCR
102417(a)
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THIS IS AN AMENDED REPORT DELIVERED ON 12/11/25
102417(a) Operation of a Family Child Care Home
The licensee shall be present in the home and shall ensure that children in care are supervised at all times...This requirement was not met as evidenced by…
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Licensee and LPA reviewed Supervising Children in Family Childcare:
https://ccld.childcarevideos.org/family-child-care-providers/supervising-children-in-family-child-care/. LPA and Licensee discussed adequate supervision and Licensee provided written summary of the video during the visit which LPAn will file.
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Based on information obtained during the complaint investigation, the licensee failed to ensure C1 was supervised at all times, resulting in C1’s injury on 9/10/25 and posing an immediate 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.
SUPERVISORS NAME: Keturah Lane
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3