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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626506
Report Date: 09/12/2025
Date Signed: 09/12/2025 02:25:33 PM

Document Has Been Signed on 09/12/2025 02:25 PM - 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/
DIRECTOR:		MAHTAB MASSOUDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 705-7577
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/12/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:52 PM
MET WITH:Massoudi MahtabTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 9/12/25 at 1:30PM Licensing Program Analyst (LPA) Mahjoba Mohsini conducted an unannounced inspection for unrelated matter. LPA met with Licensees Mahtab Massoudi. LPA was granted entry after identifying self, showing badge, and disclosing the reason for the visit. Also present in the home were Licensee's husband Kourosh Abram (who is also facility assistant) and guest (Nargis Yadullahi). During the visit there were 8 day care children (2 yrs - 3.5 yrs).

LPA interviewed Licensee, reviewed records, obtained documents. 6 children were napping and 2 were in their high chairs. Playpens where 4 children were napping had covers. LPA reminded Licensee covering crib or play pen obstructs visual observation of napping children. LPA also observed children remained in high chairs for over 30 minutes. LPA advised Licensee high chairs are only to be utilized during meal time. LPA reviewing records, LPA found there no records of sleep logs for (6 children) 2 years and younger.

Deficiencies type A and type B were cited and Civil Penalties were assessed.
See LIC809D's

Licensee was provided a copy of Civil Penalties Assessment LIC421BG. Please be advised that FAILURE
TO PAY the required civil penalty payment may result in in the REVOCATION OF YOUR LICENSE. You must
respond within 30 days with the payment of or a proposed payment plan that includes the first payment.
Further, the Department will not approve any requests for increase in capacity or for additional capacity of
additional licenses while civil penalties remain unpaid. Exit interview conducted and report was reviewed with
the Licensee Mahtab Massoudi .

Notice of Site visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Keturah Lane
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2025
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 03/09/2026 08:48 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/18/2026 09:32 PM


Created By: Mahjoba Mohsini On 09/12/2025 at 01:20 PM
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
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: 09/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/15/2025
Section Cited
CCR
102370(d)(1)

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THIS IS AN AMENDED REPORT DELIVERED ON 12/11/25
102370(d)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility obtain a California clearance.... This requirement was not met as evidence by:
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The uncleared individual, Nargis Yadullahi, was immediately removed from the home. Licensee Mahtab Massoudi stated that proof of fingerprint clearance will be submitted to the LPA by 09/15/2025.
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Based on observation, interview, and records reviewed, the licensee did not comply with the section cited above as evident by the presence of uncleared person "Nargis Yadullahi" in the Family Child Care Home which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
09/12/2025
Section Cited
CCR102425(b)(3)

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102425(b)(3) Infant Safe Sleep
Cribs or play yards shall be free from all loose articles and objects.. There shall be no objects hanging above or attached to the side of the crib.
This requirement was not met as evidenced by:
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LPA observed Licensee remove loose articles hanging over the 4 cribs.
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Based on observations, the Licensee did not comply with the section cited above as evident by 4 cribs were covered with sheets as children were napping.
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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.
Keturah Lane
NAME OF LICENSING PROGRAM MANAGER:
Mahjoba Mohsini
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/09/2026 08:49 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/09/2026 03:13 PM


Created By: Mahjoba Mohsini On 09/12/2025 at 01:40 PM
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
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: 09/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
CCR
102425(j)(2)

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THIS IS AN AMENDED REPORT DELIVERED ON 12/11/25
102425(j)(2) Infant Safe Sleep - (j) The provider shall supervise infants while they are sleeping ...(2)The provider shall check and document...
This requirement was not met as evidenced by:
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Licensee, Mahtab Massoudi states she will document observations of napping infants (up to 2 yearl old) every 15 mintues on sleep logs and email proof of documents to LPA by 9/19/25.
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Based on documents reviewed and interview with the licensee, sleep logs were not maintained for 6 infants which poses potential risk to health,
safety and personal rights of children in care.
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Type B
09/12/2025
Section Cited
CCR102423(a)(2)

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102423(a)(2)Personal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Licensee immediately removed all children from highchairs when not feeding and states she will ensure highchairs will be used during feeding with supervision.
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Based on observations, 2 children remained in highchair for at least 30 minutes. which poses a potential risk to health, safety and personal rights 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.
Keturah Lane
NAME OF LICENSING PROGRAM MANAGER:
Mahjoba Mohsini
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
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