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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626506
Report Date: 02/05/2024
Date Signed: 02/05/2024 10:11:08 AM

Document Has Been Signed on 02/05/2024 10:11 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:
02/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Mahtab Massoudi TIME COMPLETED:
10:20 AM
NARRATIVE
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On February 5th, 2024, at 8:46 am, Licensing Program Analyst (LPA) Annette Sutherland conducted a case management inspection because a deficiency was observed during a complaint inspection. Present in the home was licensee and 5-day care children. Licensees husband Kourosh Abram arrived shortly.
During a tour of the home, the following was observed: In ground jacuzzi in the backyard is not properly fenced. The home has 2 screen doors and 2 windows with access to the backyard. The Licensee has put up a fence that separates the backyard in half. The jacuzzi is still accessible to children through the kitchen sliding door and window located in the playroom.

See LIC 809D for Type A deficiency.

Please refer to regulation 102417(g)(5) for pool fencing requirements.

If there is a fence, it must meet the following criteria:
· At least 5 ft high
· The gate must be self-closing and self-latching & should not be locked.
· The latch must be within 6” of the top of the gate.
· Gate swing away from the pool
· There can’t be any gaps between posts, or between the fence and the ground that could fit anything larger than a golf ball.
· It cannot be climbable.
· You must be able to see through it into the pool area.
· There cannot be any direct access to the pool from any windows or doors.

continued on LIC 809C
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2024
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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Document Has Been Signed on 02/05/2024 10:11 AM - It Cannot Be Edited


Created By: Annette Sutherland On 02/05/2024 at 09:00 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
, 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: 02/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2024
Section Cited
CCR
102417(g)(5)

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OPERATION OF A FAMILY CHILD CARE HOME.102417(g)(5), All licensees shall ensure the inaccessibility of pools... fixed-in-place wading pools, hot tubs, spas, fishponds, and similar bodies of water through a pool cover or by surrounding the pool with a fence. This requirement was not met as evidenced by:
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Ms. Mahtab stated that she will properly fence the jacuzzi by end of business day of 2/12/24. LPA will return for plan of correction visit.
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Based on LPA's observation the Jacuzzi is accessible to children in care. The kitchen sliding door and playroom window both make it accessible to the Jacuzzi. This poses an immediate risk to the health and safety of 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:Joelle Redding
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2024


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
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: 02/05/2024
NARRATIVE
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If there is a cover, it needs to meet the following criteria:
· Support the weight of an adult.
· Secured and locked down.
· No gaps between locks that would allow a child to crawl under it.


LPA Annette Sutherland informed licensee Mahtab Massoudi that this report dated 2/5/24 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Annette Sutherland informed the licensee Mahtab Massoudi to provide a copy of this licensing report dated 2/5/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the 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 statement, must be placed in the child's file for verification.

HSC Section 1596.8595© shall be cited for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of, licensing reports indicating a Type A violation.


Exit interview conducted and report was reviewed with the LIcnesee Mahtab Massoudi. Appeal rights and notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2024
LIC809 (FAS) - (06/04)
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