<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334700051
Report Date: 08/27/2024
Date Signed: 08/27/2024 02:35:17 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/31/2024 and conducted by Evaluator Mila Quinto
COMPLAINT CONTROL NUMBER: 47-HC-20240531150749
FACILITY NAME:MAXIM HEALTHCARE SERVICES, INC.FACILITY NUMBER:
334700051
ADMINISTRATOR:DAVID KOWALCZYKFACILITY TYPE:
300
ADDRESS:34250 GATEWAY DRIVE STE 100TELEPHONE:
(760) 469-8908
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:CENSUS: DATE:
08/27/2024
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Tiffany Christofferson, DesigneeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
HCO failed to provide services to client
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/27/2024, Enforcement Analyst (EA), Mila Quinto conducted an investigation visit regarding the above complaint allegation. Upon arrival, EA met with designee Tiffany Christofferson,

During today’s visit, EA interviewed 4 staff. According to staff 1(S1) who oversee the office states staff 2(S2) is the manager that oversee the client and HCA recruitments. S2 states all clients are assessed and paired with an HCA based on schedule and experience. S2 also stated Adult 1 (A1) is a client since November 1, 2023 and brought 3 HCAs from the previous organization A1 was receiving care. A2 stated there was a report of an incident when HCA 1 was late arriving to the client’s home. However, after interviews were conducted with HCA 1 and A1, HCA 1 was not late as the HCA was outside the residence already working. Staff 3 also provided the same information. There was no disclosure from Staff 4.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 47-HC-20240531150749
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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: 334700051
VISIT DATE: 08/27/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2 of 2

Based on interview with the staff members and file review, the complaint alleging HCO failed to provide services to client is found UNSUBSTATIATED. Although the allegation may have happened or is valid, there is not enough preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

A copy of this report and appeal rights was emailed to the licensee.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2