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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603401
Report Date: 10/18/2024
Date Signed: 10/18/2024 07:19:07 PM

Document Has Been Signed on 10/18/2024 07:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ARCADIA RETIREMENT VILLAGEFACILITY NUMBER:
198603401
ADMINISTRATOR/
DIRECTOR:		VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE RDTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 200CENSUS: 84DATE:
10/18/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Shin Wook Kang, Licensee
Virgilio Agas, Administrator
Justin Lee, Manager		TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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An informal virtual conference was conducted today. The purpose of this meeting was to discuss the potential applicant’s interest in taking over the facility operations.

Present in the meeting: Araceli Ramirez (Regional Manager for Monterey Park office), Fernando Fierros (Licensing Program Manager), Bonnie Tao (Licensing Program Analyst), Shin Wook Kang (facility Licensee), Virgilio Agas (administrator), and Justin Lee (manager).

On 10/18/24, the Department conducted an virtual informal meeting with Licensee and discussed the following:
  • The control of the property and lease agreement will end due to the lease agreement will not be renewed. The tentative closing date will be on 12/31/24.
  • Licensee will reach out to the potential new applicant and schedule a meeting.

The Department requested Licensee to keep the Department updated regarding the progress of the facility closure.

Licensee agreed to provide the following to Licensing by Monday 10/21/24 next week:
  • Closure plan
  • Line list: resident roster with residents' date of birth, ambulatory status, Rent payee, responsible parties, ALW, relocation date, and relocation addresses.
  • 60- day Eviction Written Notice (Draft)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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