434412694-9-10-2021-07-CC-MSMS-C6QQ66-20210910115300

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412694
Report Date: 09/10/2021
Date Signed: 09/10/2021 11:53:06 AM

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: 10	DATE:	09/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Elham Shaheidari		TIME COMPLETED:	12:15 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 met with Elham Shaheidari, Licensee representative/director, for an unannounced Required - 1 year inspection (KIT 2). LPA toured the Facility both indoor and outdoor areas of the Facility during today's inspection. LPA notes that the Facility is licensed in Rooms 103, 104, & 105 (preschool), Room 209 (toddler option), Room 106 (play room), and Assembly Hall (assemblies & rainy day activities). LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus (posted at least one week in advance), and Activity Schedule. A review of staff records on September 10, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Elham of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period. LPA reviewed ten children's and five staff files (1 director & 4 teachers) during today's inspection Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. There is at least one staff with current CPR and First Aid certifications on file. Elham understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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: 09/10/2021

NARRATIVE

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LPA observed that the teacher/child ratio was in compliance during today's inspection. Elham understands the conditions, limitations, and capacity specifications of the Facility license. Elham understands that children shall be visually supervised at all times. LPA observed two teachers with 2 children in Room 209 (toddler) and 2 teachers with 8 children in Room 105 (preschool). Rooms 103 & 104 were not in use during today's inspection. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office.

LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Elham states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Elham understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in each Room and in the outdoor playground area via water dispensers/water bottles. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Elham states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets and in the janitor's closet inaccessible to children. Any poisons are stored in the janitor's closet. Elham states that the Facility does not administer any medication at this time.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by trees and building overhangs in the playground. There is sufficient resilient materials (rubber surfacing) in the outdoor playground area. LPA did not observe any bodies of water.

LPA conducted an exit interview with Elham prior to the conclusion of today's inspection and advised her that 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 Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC809 (FAS) - (06/04)

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