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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603401
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:00:45 PM

Document Has Been Signed on 10/16/2024 04:00 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:
10/16/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 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 conference was conducted and held today in the Monterey Park Adult and Senior Care Regional office. The purpose of this informal office meeting is to discuss the possible facility closure.

Present in this meeting: Araceli Ramirez (Regional Manager for Monterey Park office), David Sicairos (Licensing Program Manager), Bonnie Tao (Licensing Program Analyst), Luis DeLeon (Licensing Program Analyst), Mayra Cota (Licensing Program Analyst), Shin Wook Kang (facility Licensee), Virgilio Agas (administrator), and Justin Lee (manager).

On 10/08/24, the Department was made aware that the facility may possible be closing on 12/31/24. During today's meeting, the following Title 22 Regulation Sections were discussed and materials provided during the meeting.
  1. Eviction Procedures 87224 (RCFE)
  2. Health and Safety Code 1569.682
  3. Health and Safety Code 1569.191
  4. Reporting Requirement 87211 (RCFE)
(-continued on LIC 809 C-)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 VILLAGE
FACILITY NUMBER: 198603401
VISIT DATE: 10/16/2024
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Licensee, Dr. Kang, indicated the property lease will end on 12/31/24. As the landlord was not appearing to be working with Licensee in obtaining an extension of the lease agreement. Licensee agreed to continue to reach out to the landlord for possible lease extension and contact with Assisted Living Waivers (ALW) representatives for possible placement.

Licensee was agreed to provide the following to Licensing:
  • 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,
  • Transfer of P&L money
  • List of utilities and vendors
  • List of exempted staff


Per Licensee, the facility had resident census of 84 residing at the facility.

An exit interview was conducted and a copy of this LIC 809 report was provided to Administrator, Gil.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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