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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412694
Report Date: 12/03/2024
Date Signed: 12/03/2024 03:48:44 PM

Document Has Been Signed on 12/03/2024 03:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SABA ACADEMYFACILITY NUMBER:
434412694
ADMINISTRATOR/
DIRECTOR:
FATEMEH BEHZADPOURFACILITY TYPE:
850
ADDRESS:4415 FORTRAN COURTTELEPHONE:
(408) 946-5900
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY: 60TOTAL ENROLLED CHILDREN: 29CENSUS: 29DATE:
12/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Fatemeh BehzadpourTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Fatemeh Behzadpour, Director, for an unannounced case management inspection. Purpose of today's inspection: discuss facility name change and documents required to be submitted to the Department.

LPA advised Director that the following documents need to be submitted to update the Facility name change from Saba Academy to Rise Academy:

1) Updated Board Resolution.
2) Updated Application for a Child Care Center License (LIC 200A)
3) Updated Designation of Facility Responsibility (LIC 308)
4) Updated Administration Organization (LIC 309)
5) Updated Personnel Report (LIC 500)
6) Updated Emergency Disaster Plan (LIC 610)
6) Updated Admission Agreement
7) Updated Parent Handbook

Copies of Department LIC forms & a sample board resolution were provided to Director during today's inspection. Director states that she will notify LPA once all items noted above are been completed and ready to submit.

Exit interview conducted and report was reviewed with the Director, Fatemeh Behzadpour. No deficiencies issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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