434414291-9-30-2019-07-CC-SYIP-BGHLST-20190930090116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414291
Report Date: 09/27/2019
Date Signed: 09/30/2019 09:01:23 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: 7	DATE:	09/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kimberly Thunderbull		TIME COMPLETED:	10:45 AM

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) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensee Kimberly Thunderbull and explained the reason for the inspection. Present during the inspection were Licensee, her son, who helps at the day care, and 7 children. LPA toured in the inside and outside of the home. The off-limit areas of the home are living room, formal dining room, laundry room, the garage, and the entire upstairs. LPA discussed with Licensee about informing LPA if she would like to make any of the off-limit rooms accessible to the children. There are stairs and a fireplace. The fireplace is barricaded to prevent access to children. Licensee placed a barricade on the hallway which leads to the stairs. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. The furniture and the equipment, such as tables, chair, napping mats, and play yard, were age-appropriate and in good condition. The floors were clean and free of tripping hazard. LPA observed there is sufficient amount of age-appropriate toys for children in care. Bathroom for children’s use were observed to be safe and sanitary. There were no baby walkers or bouncers observed to be in use during today's inspection. Licensee understands that baby walkers and bouncers are not permitted in the home. Licensee stated that there are no weapons stored on the premise. LPA observed a fully charged fire extinguisher, carbon monoxide detector, and smoke detector. The last fire/disaster drill was conducted on 08/2019. LPA reminded Licensee to document the date of fire/disaster drills. The backyard is used and is fenced. There is a play structure in the backyard, which is anchored to the ground. Other play equipment and toys were in good condition. There were no bodies of water observed during today's inspection. --------------------continues on 809 dated 09/27/2019 page 1--------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

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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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: THUNDERBULL, KIMBERLY	FACILITY NUMBER: 434414291
	VISIT DATE: 09/27/2019

NARRATIVE

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Licensee does transport children at this time and understands that no child shall be left alone and unattended in parked vehicles.

Facility rosters was reviewed and a copy was obtained. 5 children’s files were reviewed during today inspection. The records reviewed include but not limited to immunization records. LPA observed that all children did not have immunization records on file. Licensee stated she will obtain a copy of children's immunization records.

Licensee's file was also reviewed during today's inspection. The records reviewed include but not limited the Mandated Reporter Training (AB 1207). Licensee is registered to complete her CPR/1st Aid course on 10/05/2019 and will send proof to Licensing office. Licensee stated that she has completed to Mandated Reporter Training. Licensee will send proof of immunization records for measles and pertussis.

LPA discussed Senate Bill 792 (immunization records for pertussis, measles, and flu vaccines), which began in 2016 for anyone working with the children and Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at http://www.mandatedreporterca.com.

Adults who are over the age of 18 and reside in the home are Licensee and her adult son. All adults living the home have cleared criminal records, child abuse index clearance or exemption. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, 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 violation within a 12 month period.

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SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: THUNDERBULL, KIMBERLY	FACILITY NUMBER: 434414291
	VISIT DATE: 09/27/2019

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Licensee stated that she currently does have children in care who requires IMS services. Medication is stored where it is inaccessible to the children in care. LPA discussed with Licensee about obtaining parent consent to administer any medication. LPA provided Licensee with LIC 9221: Parent Consent for Administration of Medications and Medication Consent. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Home Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed Safe Sleep information. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In areas that were evaluated during today's inspection, a Type B deficiency have been cited. An exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were discussed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST REMAIN 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: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: THUNDERBULL, KIMBERLY	FACILITY NUMBER: 434414291
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/04/2019 Section Cited	1 2 3 4 5 6 7	Immunizations. The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evident by:
	8 9 10 11 12 13 14	Based on record review, all children present did not have immunization records in file. This poses a potential risk to the health and safety to the children in care.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

LIC809 (FAS) - (06/04)

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