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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414291
Report Date: 07/09/2025
Date Signed: 07/09/2025 11:56:03 AM

Document Has Been Signed on 07/09/2025 11:56 AM - 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:THUNDERBULL, KIMBERLYFACILITY NUMBER:
434414291
ADMINISTRATOR/
DIRECTOR:		THUNDERBULL, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 663-0237
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
07/09/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Kimberly ThunderbullTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Jennifer "Jen" Beehler & Marilou Monico conducted an unannounced Case Management - Legal/Non-Compliance inspection. Upon arrival, LPAs were greeted by the licensee and provided access to the facility. LPAs stated the reason for the visit.

LPAs toured the inside and outside of the facility. There were 7 children present (2 infants, 4 preschool and 1 school-age). Licensee stated 10 children were currently enrolled. Licensee, her roommate (R1) and helper (S1) were the adults present in the home. LPAs reviewed children's files and observed two children's files missing immunization records (C1 & C2), 3 files missing LIC995A Parent's Rights (C2, C3, & C4), and 3 files with incomplete LIC9227 Individual Infant Sleep Plan. Infant sleep logs were not present for the two infants in care. LPAs reviewed the contents of the LIC9227 with licensee to ensure she understood the proper way to fill out the form and update it. LPAs discussed different options to log infant sleep times with the licensee to assist her in meeting sleep regulation standards. LPAs observed the LIC9224's dated 03/10/2025 and 04/30/2025 were present in all children's files.

Licensee did not have a file for her helper and did not have a negative TB Test on file for her roommate. Licensee's Mandated Reporter training expires 04/22/2026. Helper has completed Mandated Reporter training which expires 04/23/2026. Licensee stated she has CPR training completed as does her helper, but could not locate their cards today.

LPAs inspected the interior of the facility. LPAs observed the license and parent's rights pub was not posted near the entrance of the facility. LPAs observed the play room to have stained carpet with visible debris. LPAs discussed the cleaning regimen the licensee maintains to ensure the space is safe for children in care. Licensee stated she would thoroughly vacuum after the facility closes today and scheduled a professional carpet cleaning for 08/02/2025 in the morning during today's visit.

Continued on Page 2
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: THUNDERBULL, KIMBERLY
FACILITY NUMBER: 434414291
VISIT DATE: 07/09/2025
NARRATIVE
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During the inspection of the exterior, LPAs observed the decking on the back of the house to have soft areas and splintered wood. LPAs observed rugs dispersed throughout the decking to cover broken or worn wood planks. Licensee stated her landlord was in the process of collecting bids to replace the deck. Licensee provided LPAs with a copy of the written correspondence dated 07/08/2025.

LPAs provided the licensee with the following documents and reviewed the contents with the licensee:
  • LIC279 Application for a Family Child Care Home License
  • LIC 279B Current Children in the Home
  • Infant Sleep Log
  • LIC9227 Individual Infant Sleep Plan
  • LIC9052 Employee Rights
  • LIC9108 Statement to Report Suspected Child Abuse
  • Parent's Rights Pub


Due to today's inspection, deficiencies are cited. More information provided on the attached LIC-809D pages. Exit interview conducted with the licensee, Kimberly Thunderbull. Report was reviewed and provided along with appeal rights.
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Jennifer Beehler
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 07/09/2025 11:56 AM - It Cannot Be Edited


Created By: Jennifer Beehler On 07/09/2025 at 11:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: THUNDERBULL, KIMBERLY
FACILITY NUMBER: 434414291

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2025
Section Cited
CCR
102418(a)

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102418(a) Immunization - Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement has not been met as evidenced by:
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Licensee to collect immunization records and provided photographic proof to LPAs by the POC due date.
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C1, C2 & C3 did not have immunization records present. This poses a potential risk to the health and safety of children in care.
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Licensee to provide LPAs with photographic proof of infant sleep logs completed for the two infants in care starting 07/09/2025 until 08/01/2025 showing sleep checks have been completed every 15 minutes while infants are in care. Licensee to develop a written plan how she will continue to keep up with
Type B
08/04/2025
Section Cited
CCR102425(j)(2)(A-C)

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102425 Infant Safe Sleep - (j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: ...(2) (2) The provider shall check and document the following:
(A) Labored breathing.
(B) Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness. (C) Infants up to 12 month of age who are sleeping in a position other than on their back.
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sleep checks in the future to ensure compliance.
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This requirement has not been met as evidenced by: Licensee does not have infant sleep logs for infants in care.
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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.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2025 11:56 AM - It Cannot Be Edited


Created By: Jennifer Beehler On 07/09/2025 at 11:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: THUNDERBULL, KIMBERLY
FACILITY NUMBER: 434414291

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2025
Section Cited
CCR
102417(g)

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102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:...

This requirement has not been met as evidenced by:
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Licensee provided proof of deck issue being addressed with landlord during today's inspection. Licensee will complete a thorough vacuuming of the play room and provide LPAs with photographic proof at the end of care today, 07/09/2025. Licensee to provide photographic proof of cleaning of the carpet
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Wood decking on the back of the home has worn and splintered wooden planks and carpet in the playroom has debris and stains. These conditions pose a potential risk to the health and safety of children in care.
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by the POC due date. Licensee to email a timeline and next steps as determined by the landlord by the POC due date.
Type B
08/04/2025
Section Cited
CCR102419(d)(1)

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Admission Procedures and Parental and Authorized Representative's Rights (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A (8/06), the Caregiver Background Check Process Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

(1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver Background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).
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Licensee to provide parent's rights and have parent's sign the receipt and place it in children's files. Licensee to provide photographic proof to LPAs by POC due date.
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This requirement has not been met as evidenced by 3 children in care did not have LIC995A signed by parents and available in the children's files. This poses a potential risk to the health, safety and personal rights of children in care.
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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.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2025 11:56 AM - It Cannot Be Edited


Created By: Jennifer Beehler On 07/09/2025 at 11:38 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: THUNDERBULL, KIMBERLY
FACILITY NUMBER: 434414291

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2025
Section Cited
HSC
1597.622(a)(1)

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Immunization Requirements: (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Licensee to collect immunization records and provide photographic proof to LPAs by POC due date.
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This requirement has not been met as evidenced by H1 does not have immunization records on file. This poses a potential risk to the health and safety of children in care.
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Type B
08/04/2025
Section Cited
CCR102416(c)

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Personnel Records(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement has not been met as evidenced by:
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Licensee to provide photographic proof of CPR certificate to LPAs by POC due date. Licensee to post CPR cards on posting board for future review.
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Licensee and Helper could not produce their CPR training certificate. This poses a potential risk to the health and safety of children in care.
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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.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Jennifer Beehler
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
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