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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412694
Report Date: 08/18/2022
Date Signed: 08/18/2022 10:47:56 AM


Document Has Been Signed on 08/18/2022 10:47 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 ACADEMYFACILITY NUMBER:
434412694
ADMINISTRATOR:E SHAHEIDARI & A TAJODODIFACILITY TYPE:
850
ADDRESS:4415 FORTRAN COURTTELEPHONE:
(408) 946-5900
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY:60CENSUS: 0DATE:
08/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Elham Shaheidari and Fatemeh BehzadpourTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Mel Matos met with Elham Shaheidari, Licensee representative/director, and Fatemeh Behzadpour, teacher, for an unannounced case management inspection. No children or other staff were present since the Facility is closed for summer break and is scheduled to reopen on Monday August 29, 2022.

The Facility is currently licensed in the following rooms: 101, 102, 104, & 105 (preschool), 103, 208, & 209 (toddler option), 106 (indoor play room), and Assembly Hall. The Facility is in process of converting room 106 into a toddler option room and is in process of adding two toilets and three sinks to the same classroom.

Elham provided LPA with an updated Application for a Child Center License (LIC 200A) along with updated facility sketches during today's inspection. LPA advised Elham that a fire inspection will be requested from the San Jose Fire Department and a follow up inspection will be completed upon receipt of the approved fire inspection.

LPA provided Elham with the list of forms and documents required for new directors. Fatemeh Behzadpour will become the preschool director of the Facility as of Monday August 29, 2022.

Exit interview conducted and report was reviewed with Elham Shaheidari, Licensee representative/director. A notice of site visit was given 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: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
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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