376626506-6-9-2026-51-CC-MMOI-DUVP29-20260609105533

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376626506
Report Date: 06/09/2026
Date Signed: 06/09/2026 10:56:04 AM

Document Has Been Signed on 06/09/2026 10:56 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MASSOUDI, MAHTAB FAMILY CHILD CARE		FACILITY NUMBER:	376626506
ADMINISTRATOR/ DIRECTOR:	MAHTAB MASSOUDI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 705-7577
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92129
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	06/09/2026
TYPE OF VISIT:	Office	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Mahtab Massoudi		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/9/25 at 10:00 AM, Licensing Program Manager (LPM) Keturah Lane and Licensing Program Analyst (LPA) Mahjoba Mohsini conducted an in-office meeting with Licensee Mahtab Massoudi and she was accompanied by her husband Kourosh Abram. The purpose of this meeting is to discuss facility history, department expectations, and provide any needed guidance to ensure licensee’s understanding and compliance with Regulatory Requirements. The Licensee has been licensed since September 2015 (current location since November 2016) and has received Type A and Type B citations primarily related to infant safe sleep, personal rights and supervision requirements. There is no previous history of abuse or neglect. The facility has received two complaints with the following allegations of personal rights: 1. 09/11/2025 - Infant sustained injuries due to an unknown cause – Finding: Substantiated Citation: Type A for Lack of Supervision – 102417(a) 2. 01/30/2024 - Licensee used inappropriate form of discipline – Finding: Unsubstantiated Licensee also received a Type A citation on 9/12/25 for having an uncleared individual present in the facility (102370 (d)(1) – Criminal Record Clearance). The deficiency was corrected. In the past year the facility has received Type B citations in the following areas: 102423(a) Personal Rights, 102425 Infant Safe Sleep, 102417(g)(8)(A) Operation of a Family Child Care Home (Roster), 102416.2 Reporting Requirements and 1596.814 Family daycare home; in-ground swimming pool requirements. (continued on LIC-809C...)

NAME OF LICENSING PROGRAM MANAGER: Keturah Lane
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/09/2026

NARRATIVE

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Licensee was cited twice for not maintaining infant sleep logs on 09/19/2025 and on 08/10/2022.
Due to the facility history above the RO submitted a TSP referral on behalf of the licensee, Mahtab Massoudi, on 05/01/2026 as a resource. Licensee stated they have not received a response from TSP at this time. LPA will reach out to TSP for follow-up. Additional TSP resources were provided to Licensee. For questions related to TSP, email: Childcaretechnicalsupport@dss.ca.gov. Also provided to the licensee was Child Care Law Center website address and Child Care Advocate contact information as Licensee requested additional support.

During today’s meeting the Department discussed and provided the above listed regulations to Licensee. Licensee stated that she uses redirection and positive reinforcement with the day care children and does not use punishment or time-outs.

Applicant was provided with the CDSS Child Care Licensing (CCL) Family Child Care Providers Resource link with instructional videos: https://ccld.childcarevideos.org/family-child-care-providers/. It is recommended for Licensee to review the videos including, but not limited to: Supervising Children in Family Care, Children’s Personal Rights in Child Care, and Community Care Licensing Inspection Authority.

Licensee was advised to regularly visit the Community Care Licensing Website: www.ccld.ca.gov for quarterly updates and regulations. Applicant states that she is signed up to receive new PINs. RO advised Duty Line is available Monday – Friday 8:00AM to 5:00PM at (619) 767-2248.

Licensee, Mahtab Massoudi, states she understands that she needs to abide by Health and Safety Code and Title 22 Regulations in the operation of her Family Child Care Home.

Exit interview conducted and report was reviewed with Licensee Mahtab Massoudi. A copy of this report, full copy of the above discussed Laws & Regulations, and above handouts were also provided to Licensee, Mahtab Massoudi at the conclusion of this meeting. Appeal rights were provided and discussed.

NAME OF LICENSING PROGRAM MANAGER: Keturah Lane
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

LIC809 (FAS) - (06/04)

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