Pre-licensing visit·July 2, 2025

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.