Every finding on record at Family Comfort Care LLC

Upon patient record review, 2 of 5 (Patient #1,2) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1: The medication profile 5/8/25 contains an order for Diclofenac Sodium Gel 1% 1 apply topically daily as needed. There is not evidence of a proper dose or direction to where to apply. Corrected on site by updating medication profile. Patient 2: The medication profile 6/5/25 contains an order for 5/23/25 Voltaren Pain Gel 1% topically apply on bilateral ankles twice a day PRN pain. No evidence of a dose. Corrected on site by updating medication profile.

Upon patient record review, 2 of 5 (Patient #1,2) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 1: POC 5/8/25 contains an order for Diclofenac Sodium Gel 1% 1 apply topically daily as needed. There is evidence of a proper dose or direction to where to apply. Corrected on site by updating POC. Patient 2: POC 6/5/25 contains an order for 5/23/25 Voltaren Pain Gel 1% top Apply on bilateral ankles twice a day PRN pain. No dose on order. Corrected on site by updating POC.

Upon patient record review, 3 of 5 (Patient #1,2,3) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 1:Updated POC 5/8/25 contains goals for “Discussing health behaviors and beliefs that facilitate adaptation” and “participating in life review” there is no target date or any evidence that the goals are measurable. The updated POC contains “Identifying signs and symptoms of cardiac decompensation after activities and when to seek assistance with target date of 5/7/25 patient is in next cert period which began 5/8/25. Pt safety goals have a target date of 2/7/25, there was no evidence the goal target dates were updated. COS by adding measurable timeframes. Patient 2:Updated POC 6/5/25 contains a goal of “Demonstrating the ability to make healthcare decisions with a target date of 3/10/25. This has not been resolved and the target date has not been updated. There is another goal of Reporting and demonstrating decreased episodes of dyspnea, angina and dysrhythmias with no measurable time frame/target date to make it measurable, there was no evidence the goal target dates were updated. COS by adding measurable timeframes. Patient 3:The updated POC 5/4/25 contain goals “Verbalizing a plan to eliminate health and safety hazards” and "Verbalizing the level of knowledge, willingness and acceptance of the caregiving role." These goals contain a target date of 5/3/25, the next certification period started 5/4/25, there is no evidence the goals have been resolved and no update made to date to measure the goal for the next certification period, there was no evidence the goal target dates were updated. COS by adding measurable timeframes.