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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700987
Report Date: 09/30/2025
Date Signed: 09/30/2025 11:03:03 AM

Document Has Been Signed on 09/30/2025 11:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:MAXIM HEALTHCARE SERVICES, INC.FACILITY NUMBER:
194700987
ADMINISTRATOR/
DIRECTOR:		KOWALCZYK, DAVIDFACILITY TYPE:
300
ADDRESS:1000 S FREMONT AVE A1010300TELEPHONE:
(626) 759-9154
CITY:ALHAMBRASTATE: CAZIP CODE:
91803
CAPACITY: CENSUS: DATE:
09/30/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Solomon Johnson - Field Support ManagerTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Maxim Healthcare Services, Inc on 9/30/25 for a post licensing inspection, EA met with Field Support Manager Solomon Johnson. The proper posting of business hours and license was observed. The proof of insurance records were reviewed. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with Mr. Johnson and informed him that no discrepancies were found.

EA Chan concluded the visit with an exit interview and provided a copy of this report to Mr. Johnson.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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