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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603401
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:49:46 PM

Document Has Been Signed on 11/05/2024 04:49 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: 83DATE:
11/05/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Shin Wook Kang, Licensee
Virgilio Agas, Administrator
Justin Lee, Manager		TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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The resident council president, Lyndon Larsons, invited Licensing to join the resident council meeting today which was hosted at the facility. The purpose of this meeting was to discuss and answer residents' questions regarding the facility closure and the changes.

The following participants were invited to present in the meeting: Fernando Fierros (Licensing Program Manager), Bonnie Tao (Licensing Program Analyst), Shin Wook Kang (facility Licensee), Justin Lee (manager), and Ombudsman Elislda Herrera.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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