Golden Harvest Care Home 3

Type of visit: Required - 1 Year

On 8/14/26, at 09:20am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annually required inspection visit to Golden Harvest Care Home 3. LPA was met by Chester Moore, Administrator, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) elderly adults aged 60 and over. Approved for six (6) non-ambulatory; a waiver was granted for hospice care of six (6) residents. Currently, the home has (5) residents. The facility’s annual fees are current. The facility is a single-story structure located in a residential neighborhood. It consists of three (3) bedrooms, 1 and 1/2 (1.5) bathrooms, living area, dining area, kitchen, outside sitting area, and an attached garage. At 9:30am, LPA and staff toured the facility. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for resident’s personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there was adequate lighting, and sufficient toiletries were accessible to residents. The water temperature measured 114.9f degrees in the bathroom. A comfortable temperature is maintained in the facility. Report Continued On LIC809-C LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available for the residents. All food items were stored properly. The water temperature in the kitchen measured 115.5f degrees. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked with manual. The fire extinguishers were charged and last inspected on 08/05/2026. The smoke and carbon monoxide detectors were operable. The last fire/emergency drill was conducted on 08/01/2026. The facility’s administrator’s certificate (7036537740) was valid from 03/28/2026 through 03/27/2028. The facility’s liability insurance was valid from 06/18/2026 through 06/18/2027. LPA conducted a review of (5) resident records, (4) staff records, and reviewed the facility disaster plan. LPA observed that residents had the required documents in their file. Staff records were complete with required documents and training. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (5) client medication administration records, and medication, and did not observe any discrepancies at the time of visit. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA observed that the facility had the required postings, posted throughout the facility. LPA advised the facility to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues. No deficiencies were cited during this inspection visit. An exit interview was held, and a copy of this Facility Evaluation Report was provided to Chester Moore, Administrator.the state’s words, verbatim · CDSS document, Aug 14, 2026

Type of visit: Prelicensing

On 7/02/25, at 1:00pm, Licensing Program Analyst (LPA) Perry Scott conducted an announced visit to Golden Harvest Care Home 3. LPA was greeted by applicant, Tracy Moore, and Chester Moore, Administrator. LPA explained the purpose of today’s Pre-licensing inspection visit. An application was submitted to Community Care Licensing Division (CCLD) on 01/22/25 in the initial license application for a Residential Care Facility for the Elderly aged 60 and over. The applicant requested a capacity of six (6) non-ambulatory individuals. Structure: The home is a three (3) bedroom, one and ½ (1.5) bathroom, single-story home with an attached garage situated in a residential neighborhood. The home includes a living room, activity room, kitchen, and laundry area. The living area included four (4) recliners, fireplace, and a television. The dining area included a dining table and six (6) chairs, office area, and a television. The kitchen has a refrigerator, stove, toaster oven, coffee maker, and a microwave oven. The rear exterior is fenced throughout with a shaded patio that includes a table and chairs. The front porch has a table with two (2) chairs for the residents to sit. The passageways, walkways, and steps are free from obstructions. The front and back entrances are wheelchair accessible. Bedrooms for Residents: The facility has three bedrooms (3) bedrooms approved for two (2) non-ambulatory residents per room. All rooms included twin-size beds, two (2) chairs, two (2) nightstands, and table lamps. All bedrooms are equipped with a ceiling lighting, and a dresser. All rooms had closets for ample storage. Report Continued on LIC809-C Bedrooms for Staff: There is no bedroom designated for live-in staff. Bathrooms: The home has one and 1/2 (1.5) bathrooms. One bathroom has a working toilet, washbasin, shower with grab bars, and non-skid mats. The ½ bath has a washbasin and a working toilet. Linens & Hygiene Supplies: Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the hall storage area. Emergency Phone Numbers, Exit Plan & Menu: The emergency disaster plan is posted along with the exit plan in the living room. There are two (2) fire extinguishers; one located in the kitchen and the other in the hallway. The facility has a land line telephone located in the kitchen. The applicant has submitted a mitigation plan. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked cabinet. Food supply is adequately stored in kitchen cabinets and consists of can and other dry goods. The facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days that were observed. Smoke Detectors: Smoke and carbon monoxide detectors throughout the interior space are operable. Toxins & Kitchen: All toxins are locked and stored under the kitchen sink. Stove burners, oven, washer and dryer are working. There is one (1) refrigerator in the kitchen. The refrigerator measured a temperature of at least 45 degrees Fahrenheit for appropriate food storage. The home is equipped with a heater and air conditioning. Report Continued on LIC809-C Water Temperature: The hot water temperature measured 114.3F degrees. Medications, First-Aid Kit & Book: A first aid kit and manual are stored in the medication cabinet, which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, and gauze that is locked and inaccessible to residents. The resident's medications will be stored in the same medication cabinet locked in the living room area and inaccessible. Resident & Staff Files: Records of staff and residents will be stored in a locked cabinet in the living room. Reading Material & Games: The facility has board games, books, magazines, and other recreational materials for the resident's use, stored in the activity room. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool in the fenced area. Fire clearance: A fire clearance inspection was conducted on 02/13/2025 and approved for a capacity of six (6) non-ambulatory residents. LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on front and back exits. Component III: LPA and the applicant completed the Component III PowerPoint presentation, which gives an overview of what to expect while running a Residential Care Facility for the Elderly. During the pre-licensing inspection no items were observed which do not comply with applicable laws and regulations; no items require a follow up inspection for verification of correction. Pre-Licensing is complete, and this facility has no deficiencies. The department will submit a copy of this Facility Evaluation Report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application. An exit interview was conducted, and a hard copy of this Facility Evaluation Report has been furnished to the applicant, Tracy Moore, and Chester Moore, Administrator.the state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Tracy Moore (Managing Member) & Chester Moore (Administrator) Interview Method: Virtual interview via Microsoft Teams On June 11, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 11, 2025