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

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700051
Report Date: 08/27/2024
Date Signed: 08/27/2024 02:34:42 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/27/2024 02:34 PM - 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:
334700051
ADMINISTRATOR/
DIRECTOR:		KOWALCZYK, DAVIDFACILITY TYPE:
300
ADDRESS:34250 GATEWAY DRIVE STE 100TELEPHONE:
(760) 469-8908
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY: CENSUS: DATE:
08/27/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Tiffany Christofferson, DesigneeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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
Enforcement Analyst (EA), Mila Quinto arrived at the business office of Maxim Healthcare for a biennial inspection. Upon arrival, Analyst Quinto was greeted by designee, Tiffany Christofferson. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. The Analyst reviewed the personnel and administrative files. Based on the file review, analyst informed the designee there was no discrepancy found.

The analyst provided a copy of the report to the designee via email.

LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my 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.

HCS809 (FAS) - (06/04)
Page: 1 of 1