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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412694
Report Date: 08/29/2019
Date Signed: 08/29/2019 03:27:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SABA ACADEMYFACILITY NUMBER:
434412694
ADMINISTRATOR:ELHAM SHAHEIDARIFACILITY TYPE:
850
ADDRESS:4415 FORTRAN COURTTELEPHONE:
(408) 946-5900
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY:60CENSUS: 20DATE:
08/29/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Amnah AlmamoriTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Mel Matos and Peter Tinkelenberg met with Amnah Almamori, ECE preschool director, for an unannounced case management inspection. Amnah contacted LPA Matos prior to today's inspection to inquire about adding additional space to the existing license. Amnah states that the licensed capacity will remain unchanged.

LPAs advised Amnah that she will need to submit the following to request the addition of space to the existing license.

1) Application for a Child Care Center License (LIC 200A)
2) Updated Facility sketches (Indoor)
3) Updated Emergency Disaster Plan
4) Updated Personnel Report

LPAs advised Amnah that a fire safety inspection from the San Jose Fire Department will be requested upon receipt of the items listed above.

LPAs also provided Amnah with a list of documents required for director/Licensee representative in case the Facility elects to designate Akram Tajadodi as Facility director/Licensee representative in the near future.

No deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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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