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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434414291
Report Date: 12/30/2020
Date Signed: 12/30/2020 06:31:51 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2020 and conducted by Evaluator Melvin S Matos
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20201014090121
FACILITY NAME:THUNDERBULL, KIMBERLYFACILITY NUMBER:
434414291
ADMINISTRATOR:THUNDERBULL, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 663-0237
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 1DATE:
12/30/2020
ANNOUNCEDTIME BEGAN:
06:00 PM
MET WITH:Kimberly ThunderbullTIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Licensee is caring for children in off limits area
Licensee did not treat children with dignity or respect
Licensee used prohibited equipment
Licensee did not properly sanitize child's bottle
Licensee inappropriately disciplined child
Personal Rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mel Matos conducted an announced tele-investigation via FaceTime (#408-663-0237) with Kimberly Thunderbull, Licensee, today. Purpose of today's tele-investigation: deliver investigation findings.

The investigation of the six complaint allegations listed in this complaint was conducted by LPA Mel Matos. LPA notes that the Personal Rights allegation listed above was regarding whether the Licensee has illegal drugs in the home. Based on the available evidence and interviews completed for the complaint investigation, it is concluded that although the allegations noted on this complaint may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. The allegations are thus UNSUBSTANTIATED. LPA Matos to forward a copy of today’s report to Kimberly Thunderbull, Licensee, via email (kjennings71@gmail.com).
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20201014090121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/30/2020
NARRATIVE
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LPA requested that Kimberly respond to the “read receipt” confirmation/send confirmation of receipt email to LPA within 24 hours confirming receipt of today’s report. A Notice of Site Visit will also be forwarded to Kimberly via email and will be required to be posted near the entrance to the home for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2