434414291-3-10-2025-07-CC-SCES-DEYS6Z-20250321133643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414291
Report Date: 03/10/2025
Date Signed: 03/10/2025 12:47:23 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
02/10/2025 and conducted by Evaluator Deanna Villagrana

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20250210094508

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:	03/10/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kimberly Thunderbull		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Licensee is not providing parents with full licensing reports as notification of a Type A Deficiency.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Deanna Villagrana met with licensee Kimberly Thunderbull to deliver findings for the above allegation. LPA explained the nature of the visit. Present were licensee, licensee's roommate, assistant Angel Jauregui and seven day care children including three infants.

Based on LPA's interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Licensee failed to provide type A reports for the following dates to parents of children in care. Dates are 03/18/2024, 04/17/2024 and 05/08/2024. California Code of Regulations, Health and Safety Code 1596.80, are being cited on the attached LIC9099D.

LPA Deanna Villagrana informed licensee Kimberly Thunderbull that this report dated 03/10/2025 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 07-CC-20250210094508

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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: THUNDERBULL, KIMBERLY	FACILITY NUMBER: 434414291
	VISIT DATE: 03/10/2025

NARRATIVE

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Also, LPA Deanna Villagrana informed the licensee Kimberly Thunderbull to provide a copy of this licensing report dated 03/10/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Susy Cervantes	TELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 07-CC-20250210094508

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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: THUNDERBULL, KIMBERLY	FACILITY NUMBER: 434414291
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/11/2025 Section Cited HSC 1596.8595(c)	1 2 3 4 5 6 7	A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.	1 2 3 4 5 6 7	Licensee will submit LIC9224 for all children in care for reports dated 03/18/2024, 04/17/2024 and 05/08/2024 to CCLD by POC date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by Licensee failed to provide type A reports for the following dates to parents of children in care. Dates are 03/18/2024, 04/17/2024 and 05/08/2024. This poses a potential risk Health, Safety Personal Rights risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Susy Cervantes	TELEPHONE: (408) -32-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025

LIC9099 (FAS) - (06/04)

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