Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted a case management visit to follow up and issue citation on information provided to the department on a Special Incident Report (SIR) dated 4/27/26. LPA met with Jennifer Estrada - House Lead and explained the reason for the visit.

LPA received an SIR on 4/28/26 that explained the following:

-On 4/27/26 South Central Los Angeles Regional Center conducted their Annual Audit, during visit the following medication error was discovered: Client #1 (C1) had a medication (Metoprolol Tartrate 25mg 1 tab) that was discontinued on 04/21/2026 and medication was being distributed until 04/26/2026, C1 did not suffer any adverse effects due to the medication error. The discontinued medication was halted immediately, the Registered Nurse (RN) and Pharmacy were phoned at the time of incident, the pharmacy repacked the bubble packs accordingly and the medication bubble packs were picked up by staff on 04/27/2026.

(staff have been In Serviced by RN on the importance's of discontinued medications and ensuring that all medications are properly stored)

-During todays visit LPA confirmed with Jennifer that the above medication error occurred and she stated that all staff that assist with medication have been retrained and provided LPA with the proof of training that was completed on 4/28/26.

*due to this being a repeat violation an immediate $250 civil penalty will be issued, previous citation for regulation 80075(b) was issued 9/26/26 during a complaint investigation for Complaint # 28-AS-20250910143108 *

The deficiency cited will be detailed on the LIC 809-D page per Title 22 regulations. Exit interview was conducted and a copy of this report, 809D, and appeal rights were provided.