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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 564700025
Report Date: 04/10/2025
Date Signed: 04/10/2025 10:01:52 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
03/04/2025 and conducted by Evaluator Joshua Rarela
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250304093712
FACILITY NAME:MAXIM HEALTHCARE SERVICES, INC.FACILITY NUMBER:
564700025
ADMINISTRATOR:KOWALCZYK, DAVIDFACILITY TYPE:
300
ADDRESS:300 E ESPLANADE DR, STE 1500TELEPHONE:
(805) 981-2539
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:CENSUS: DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Richard Ortiz, Director of Business OperationsTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Home Care Organization (HCO) failed to provide services to a client as contracted
INVESTIGATION FINDINGS:
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Complaint Investigation. The EA met with the individual named above and discussed the findings.

During the course of the investigation, EA conducted interviews with the Home Care Organization (HCO) personnel and reviewed records including the disciplinary actions taken by the HCO along with the Home Care Aide (HCA) criminal record history and records from the HCA Registry Database.

The investigation revealed that an HCA recorded working hours provided to a client when the HCA did not in fact show up to the client's home to provide services, and thus leading to the allegation of the HCO's failure to provide services to a client as contracted. The HCO discovered the HCA's falsification of their work hours when they checked their system after being notified by the client that the HCA did not show up to provide services. (CONTINUED)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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-20250304093712
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: 564700025
VISIT DATE: 04/10/2025
NARRATIVE
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The HCO terminated the HCA's employment as a disciplinary action. There was insufficient evidence to suggest that the HCO intentionally failed to provide services as contracted to the client.

Based on the EA's observations, interview and records review, there was insufficient evidence to prove the allegation as the preponderance of evidence standard was not met although the allegation may have happened or is valid, therefore the allegation is found to be unsubstantiated. A copy of this report was provided via electronic mail.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2