Clement Care Medical

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cynthia Chan conducted a follow-up visit to verify corrections from the prelicensing visit on 8/25/26. LPA met with Applicant Joseph Ntung. The following items were to be corrected by 9/1/26. * The hot water temperature must be measured within the required range of 105-120 degrees F. * Auditory devices on the exit doors. * The backyard has uneven pavement, which can be a tripping hazard to residents. * Local Ombudsman poster During the visit today, LPA observed operable auditory devices on the exit doors. The uneven areas of the backyard have been paved to smooth out the walkway. The ombudsman poster is posted. However, the hot water temperature in the bathrooms and kitchen sink was measured between 127 - 138 degrees F, which is over the required range of 105-120 degrees F. The proof of correction for the hot water temperature shall be submitted to LPA by 9/18/26. An exit interview was held, and a copy of this report was given to the applicant.the state’s words, verbatim · CDSS document, Sep 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Cynthia Chan conducted an announced visit to the facility for the purpose of a pre-licensing inspection. An application was submitted to CCLD on 07/01/2026 for an initial license for a Residential Care Facility for the Elderly to serve the Elderly, ages 60 years and older. The requested capacity is for (5) residents, ages 60 and over, of which (3) may be non-ambulatory, (1) bedridden, and (1) ambulatory. Bedroom #4 is approved for the bedridden resident. Bedroom #5 is approved for (1) ambulatory only resident. The hospice waiver is granted for (5) residents. LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility. Infection Control: The licensee has an Infection Control Plan and a lead staff designated to conduct training. Licensee will provide ongoing staff training on the infection control plan. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. The liability insurance of $1,000,000 per occurrence and $3,000,000 total aggregate will be secured once the facility is licensed. Structure/Physical Plant: The facility is a single story home with (5) private resident bedrooms, 3 bathrooms, living room, dining area, and kitchen. The bathrooms have non-skid mats in the shower area and grab bars. The bedrooms have sufficient storage space and appropriate lighting. Facility has smoke and carbon monoxide combo detectors and are interconnected. Knives, sharps, and cleaning products are locked in the kitchen cabinets. The front yard has a carport and a covered patio. The backyard has a covered patio with a table and chairs. No swimming pool or body of water on the premises. Food Service: There is a sufficient food supply of 2-day perishable and at least a week of non-perishable food maintained at the facility. All the appliances are in working order. Sufficient amount of tableware, dishes, and utensils are observed. The refrigerator is maintained at the maximum of 40 degrees F or below and the freezer at 0 degrees F or below. Staff and Residents files: Staff and Residents files will be maintained at the facility. Resident Rights/Information: Resident rights, Resident councils, and complaint posters are posted in a prominent area. Planned Activities: The facility has sufficient space to accommodate indoor and outdoor activities. Incidental Medical and Dental: Medications will be centrally stored and locked in the file cabinet not accessible to residents. The first aid kit contains all the required supplies along with the current first aid manual. Disaster Preparedness: The facility has the Emergency Disaster Plan with contact numbers, relocation sites, and evacuation procedures. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The facility landline is (626) 269-0251. Component III was conducted during the visit today. Pre-licensing is incomplete and the following must be corrected and submitted to LPA by 9/1/26. * The hot water temperature must be measured within the required range of 105-120 degrees F. * Auditory devices on the exit doors. * The backyard has uneven pavements which can be a tripping hazard to residents. * Local Ombudsman poster An exit interview was held, and a copy of this report was given to the applicant.the state’s words, verbatim · CDSS document, Aug 25, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 5 Census (if any clients in care): 0 COMP II Participants: Joseph Ntung CEO/ Administrator Interview Method: Telephone interview On August 5, 2026, 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 the 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 Readiness 9. Pre-licensing Facility Grounds Inspection and Operational Readinessthe state’s words, verbatim · CDSS document, Aug 5, 2026