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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626506
Report Date: 02/21/2024
Date Signed: 02/21/2024 08:53:09 AM

Document Has Been Signed on 02/21/2024 08:53 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 CAREFACILITY NUMBER:
376626506
ADMINISTRATOR:MAHTAB MASSOUDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 705-7577
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
02/21/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Mahtab MassoudiTIME COMPLETED:
09:10 AM
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On February 21, at 8:10am Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced plan of correction inspection today. The purpose of this visit was to observe correction to deficiency cited on 2/5/24 about the Jacuzzi being accessible through the kitchen sliding doors. Upon arrival, LPA met with Licensee, Mahtab Massoudi also present was licensee’s husband Kourosh Abram and 5 children were present in care. All adults have the required background clearances and facility is within staffing ratio during today's inspection.

LPA conducted a tour of the day care areas. Corrections observed today: Jacuzzi is fenced but the gate does not self-latch. LPA advised that.
The gate must be self-closing and self-latching & should not be locked.


Deficiency has not been cleared.

Licensee will make correction and submit proof of self-latching door by 2/26/24.

A Notice of Site Visit was posted during the inspection, and it must remain posted for a period of 30 days. Failure to keep notice posted will result in a civil penalty of $100.00. Provided appeal rights to licensee today.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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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