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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700051
Report Date: 04/01/2026
Date Signed: 04/01/2026 03:01:24 PM

Document Has Been Signed on 04/01/2026 03:01 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:47250 WASHINGTON ST, STE BTELEPHONE:
(760) 469-8908
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY: CENSUS: DATE:
04/01/2026
Annual/RandomANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Tiffany Christofferson, ManagerTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Enforcement Analyst (EA), Jane Cong-Huyen, with the Home Care Services Branch (HCSB) conducted a virtual visit for the purpose of a biennial inspection. EA met with the HCO representative,Tiffany Christofferson, Manager . Per virtual tour of the facility, EA observed the posting of the license and operating business hours. Business operating hours are from 8:00am - 6:00pm, Monday through Friday.

During the inspection, EA reviewed personnel records for Home Care Aides (HCAs) including fingerprint status, HCA registry status, Tuberculosis (TB), and required training(s). EA also reviewed the HCO’s business records for insurance requirements.



EA Cong-Huyen found the HCO in compliance and no deficiencies were cited. An exit interview was conducted, and a copy of this report (HCS809) was provided to the HCO representative, Tiffany Christofferson, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2026
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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