Golden Harvest Care Home 2

Type of visit: Required - 1 Year

On 06/30/2026, at approximately 11:00 AM, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced annual required visit. LPA met with Licensee Tracy Moore. The facility is licensed to serve six (6) residents aged 60 and above, all of whom may be non-ambulatory. The facility has a hospice waiver approved for a maximum of six (6) hospice residents. There are currently five (5) residents in care. The facility is a single-family home located in a residential area and consists of a kitchen, dining room, office area, living room, three (3) bedrooms, two (2) bathrooms, garage, storage area for supplies, and a backyard with shade. LPA conducted a tour of the physical plant. No obstructions were observed on the premises. A covered jacuzzi was observed in the backyard. LPA inspected three (3) bedrooms and two (2) bathrooms. Beds and bedding supplies were observed to be in good condition. Adequate lighting was provided, and storage space for residents’ personal belongings was observed. Bathrooms were clean and equipped with grab bars and non-slip mats. Smoke detectors and carbon monoxide detectors were tested and found to be operable and in good condition. The water temperature was tested at 116 degrees Fahrenheit. During the visit, the facility was observed to be clean, sanitary, and appropriately furnished. Personal hygiene items were stored appropriately. Cleaning supplies, toxins, and sharp objects were stored in a manner that made them inaccessible to residents in care. The kitchen was inspected, and sufficient perishable and non-perishable food supplies were observed and adequately maintained. Please see report continuation on (LIC809-C) LPA reviewed five (5) resident files and five (5) staff personnel files. Fire and disaster drill documentation was observed during the file review. LPA reviewed Medication Administration Records (MARs). The medications were centrally stored and inaccessible to residents. No issues were observed during the medication review. The facility’s infection control documentation was also reviewed. Technical assistance was provided to inform the Administrator to add the assembly point to the facility sketch. See (LIC 9102). Required posters were displayed throughout the facility. A copy of the facility’s liability insurance was provided for review. No deficiencies were observed during today’s visit. An exit interview was conducted, and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 30, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 7/10/2025, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Chester Moore/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve six (6) residents aged 60 and above of which (6) can be non-ambulatory. Hospice waiver approved for a maximum of (6) hospice residents. Currently there are (5) residents in care. The facility is a single home located in a residential neighborhood. It consists of a Kitchen, Dining Room, Living Room, (3) three bedrooms, (2) two bathrooms, a Garage, Storage for all supplies, and a backyard with shade. LPA Iniguez and the Administrator toured the physical plant. There were no obstructions on the premises, a covered jacuzzi was in the back yard. LPA inspected a total of (3) bedrooms and (2) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature properly measured between 105F° and 120F°. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 6/15/25. A review of (3) residents' service files and (3) staff personnel files. LPA reviewed (3) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of the liability insurance will be emailed to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Chester Moore/Administrator.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Census (if any clients in care): Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Mar 12, 2024