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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434414291
Report Date:
07/09/2019
Date Signed:
07/09/2019 09:44:32 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:
THUNDERBULL, KIMBERLY
FACILITY NUMBER:
434414291
ADMINISTRATOR:
THUNDERBULL, KIMBERLY
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 663-0237
CITY:
GILROY
STATE:
CA
ZIP CODE:
95020
CAPACITY:
14
CENSUS:
11
DATE:
07/09/2019
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Kimberly Thunderbull
TIME COMPLETED:
09:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced POC inspection. LPA met with Licensee Kimberly Thunderbull and explained the reason the inspection. Licensee was cited on 06/03/2019 under
CCR 102424(a)(3)
Personal Rights. Licensee stated that she submitted written plan on 06/27/2019. Licensee provided a copy of written plan to LPA during today's inspection. Citation was cleared during the inspection and a Deficiency Clearance Letter has been provided to Licensee.
No deficiencies as been cited as result of today's inspection.
An exit interview was conducted were this report was discussed and provided to Licensee. A notice of site visit has been issued and must be posted for 30 consecutive days.
SUPERVISOR'S NAME:
Anthony Studebaker
TELEPHONE:
(408) 324-2148
LICENSING EVALUATOR NAME:
Samantha Yip
TELEPHONE:
(408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE:
07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/09/2019
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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