434412694-3-4-2022-07-CC-MSMS-CC7RDC-20220304115544

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412694
Report Date: 03/04/2022
Date Signed: 03/04/2022 11:55:51 AM

Document Has Been Signed on 03/04/2022 11:55 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
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: 19	DATE:	03/04/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:45 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 Analysts (LPAs) Mel Matos and Aman Sharma conducted an unannounced case management inspection today. Purpose of today's inspection: Facility has requested the addition of additional classroom space to the existing license. The existing capacity remains unchanged. LPAs met with Licensee Elham Shaheidari, Licensee representative/director and explained the nature of today's inspection to her. Facility is requesting to add Rooms 101, 102, and 208 to the existing license. LPAs toured the indoor and outdoor areas of the Facility with Elham during today's inspection. The following rooms are for the preschool: Rooms 101, 104, 105, and 209. The following rooms are for the toddler option: Room 103, & 208. Measurements are as follows: ROOM 101: (11.833 x 4.500 = 53.248) + (24.167 x 19.333 = 467.220) minus (4.083 x 2.083 = 8.504) encumbered space = 511.964 ROOM 102: 28.000 x 21.417 = 596.676 minus (4.1 x 2.1 = 8.610) + (8.167 x 1.417 = 11.572) encumbered space = 576.494 ROOM 103: (Toddler Option): 24.166 x 27.830 = 672.539 minus (1.249 x 6.000 = 7.494) encumbered space = 665.045 ROOM 104: 27.747 x 21.581 = 598.808 minus (1.249 x 6.000 = 7.494) encumbered space = 591.314 ROOM 105: 38.000 x 21.167 = 804.346 minus 9.822 encumbered space = 794.524 ROOM 208: (Toddler Option): 33.083 x 16.000 = 529.328 ROOM 209: (Toddler Option) 43.417 x 21.167 = 919.007 minus 54.615 encumbered space = 864.392 *TOTAL INDOOR CLASSROOM SPACE: 4,533.061 sq. ft. divided by 35 = 129 children.*

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

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: 03/04/2022

NARRATIVE

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ROOM 106 (Indoor Activity Room): 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.

Room 106 to be used as an Indoor Play Room and the Assembly Hall to be used for assemblies and rainy day activities. There is sufficient sinks, toilets, chairs, tables, cubbies/hooks, and equipment for the children within the Facility. Playground equipment is age appropriate with rubber surfacing used as resilient material. A waiver is on file for playground space.

Playground measurements:

109.166 x 25.083 = 2738.211 divided by 75 = 36 children

A fire clearance from the San Jose Fire Department was received prior to today's inspection. However, Elham requested to also add Room 208 to the Facility license during today's inspection and that room was not included in the original fire clearance approval from the San Jose Fire Department.

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 (20 toddler option & 40 preschool children) will be effective upon completion of the following item:

1) Updated fire clearance approval with the addition of Room 208 has been received from the San Jose Fire Department.

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: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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