434412694-8-26-2020-07-CC-MSMS-BSUT59-20200826142509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412694
Report Date: 08/26/2020
Date Signed: 08/26/2020 02:25:39 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 ACADEMY		FACILITY NUMBER:	434412694
ADMINISTRATOR:	E SHAHEIDARI & A TAJODODI		FACILITY TYPE:	850
ADDRESS:	4415 FORTRAN COURT		TELEPHONE:	(408) 946-5900
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95134
CAPACITY:	60	CENSUS: 0	DATE:	08/26/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elham Shaheidari		TIME COMPLETED:	02:30 PM

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	Licensing Program Analyst (LPA) Mel Matos conducted an announced tele-prelicensing inspection of the Facility via video call (FaceTime). LPA met with Licensee Elham Shaheidari, Licensee representative/director and explained to her that due to the COVID-19 situation and "Shelter in Place" Order, today's Facility Evaluation Report (LIC 809) is being generated remotely and will be emailed to her upon the completion of today's tele-prelicensing inspection. Elham's reply to the email will serve as acknowledgement that the report was received. Purpose of today's tele-prelicensing inspection: Facility is requesting to add Room 106 (Indoor Play Room) and Assembly Hall (assemblies & rainy day activities) to the existing license. The capacity remains unchanged. The following rooms are for the preschool: Rooms 103, 104, & 209. The following room is for the toddler option: Room 209 (formerly Janitorial Room). Measurements are as follows: ROOM 103: 24.166 x 27.830 = 672.539 minus (1.249 x 6.000 = 7.494) = 665.045 ROOM 104: 27.747 x 21.581 = 598.808 minus (1.249 x 6.000 = 7.494) = 591.314 ROOM 105 (Toddler option): 38.000 x 21.167 minus 9.822 (encumbered space) = 794.524 ROOM 209: 43.417 x 21.167 minus 54.615 (encumbered space) = 864.392 *TOTAL INDOOR CLASSROOM SPACE: 2,915.275 sq. ft. divided by 35 = 83 children.* ROOM 106: 34.333 x 14.500 = 497.828 square feet divided by 75 = 14 children ASSEMBLY HALL: 65.747 x 26.830 = 1763.992 square feet divided by 75 = 23 children.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 ACADEMY	FACILITY NUMBER: 434412694
	VISIT DATE: 08/26/2020

NARRATIVE

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There is sufficient sinks, toilets, chairs, tables, cubbies and equipment for the children within the Facility. The playground measurements remain unchanged.

A fire clearance from the San Jose Fire Department was received prior to today's tele-prelicensing inspection.

Elham understands that the toddler option and preschool children cannot be commingled and that the Facility must follow the appropriate ratios for the toddler option and preschool children.

LPA conducted an exit interview and advised Elham that the license for 60 children (12 toddler option & 48 preschool children) is approved effective today, August 26, 2020.

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 Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020

LIC809 (FAS) - (06/04)

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