User Manual - Assisted Living Residence and Comprehensive
Contents
1. mm ddiyyyy a Discharged In House 1O 2 0O10 2 00102 0O12 Conversely when the Discharged radio button is selected the ADL Medication Cognitive Impairment section as well as the Discharge Disposition section are activated Page 9 of 12 NJ Assisted Living Resident Profile Survey User Guide Reoakdonlthienatet Gender Ciise Fermats Medeaed Status Cives NMe Date a Owe imedai ia as irma Amission Source v Rerpie Staire Respete Oh Nor Reagite Discharged Please enter one of ihe tofowing codes b ident ech residents reed for a6aestance 0 independent Resident needs no assistance in percermng fhe actively a 1 mied Resident needs some SS e05tance in Petorming he acini 2 Total Resident cs totally Gependent upon others for the aciri Dressing 9102 Gating 00102 Tote 90102 Tane 000102 Locomaion C9 O102 Bed Modit O9O102 Ean O00102 Med Admin Status 90102 Copie Sls 90102 Resxient had a health sanace plan as of the last available data prior fo the date of discharge Yes No Resident had a managed nak agreement as of the tast available data prior bo he date of discharge Yes No Diecharnge Des positeon Ces charge Date imami Faclty Cescharged To Reason tor Cuscharge Complete Status inProcess Complete 4 5 Printable Clinical Worksheets Users have the ability to print a worksheet listing resident identifier and ADL information This feature is provided as a direct res2. is not selected the Respite Status field for each resident will not be active Please note if the respite box is selected and completed resident profiles exist the system will allow you to deselect the respite box If you deselect the respite box you will be notified that any completed resident profiles will be reset to in process Medicaid Contractual Information This section asks providers to indicate if the facility or program has a Medicaid provider number If no is selected the Medicaid status field of each resident s profile will be inactivated If yes is selected the Medicaid status field for each resident must be completed Please note if you wish to change the answer to this question from no to yes and completed resident profiles exist the system will allow you to make the change Once the change has been made any completed resident profiles will be reset to In Process Staffing Information This section asks the user to indicate the total number of full time employees including the number of contractual service workers Page 4 of 12 NJ Assisted Living Resident Profile Survey User Guide CMA Information This section contains two questions related to the use of certified medication aide programs The New Jersey Department of Health Division of Health Facilities Evaluation and Licensing Assisted Living Residence and Comprehensive Personal Care
3. Home Resident Profile Survey Facility Information Facility Neme Assisted Living Residence Facility Profile License Number 850123 Facility Name Assisted Living Resid Facility Address 750 Alexander Rosd City Princeton Ze 08540 County Mercer gt State NU x Telephone E0 275 4000 Extension Fee Administrator First Name Assisted Living Last Name Professional Telephone Extension Credentials gt z Email a Pr gt Contact Information First Name Assisted Livin Last Name Professional Telephone 609 275 4000 Extension Does your facility provide Alzherner s services Yes C No Please indicate C Separate Alzheimer s unit C integrated unit All residents entire facility Are there any other special services provided Yes C No Please imcicate Respite l Hospice Behavior management Other indicate below Medicaid Contractual Information Does your facility have a Medicaid provider number C Yes No Staffing Information Tote number of full time equivalents including contracted service workers CMA Information Does your organization have an active certified medication aide program in which CMAs sdminister medicatons as of 12 317 ves No Does your organization have an in house certified medication aide training program as of 12 317 C ves No Other Contact for this Facility First Name Last Name Email Title Phone Assisted Liv
4. last year s data wt Ore vou sure you want to add a resident Cancel If you wish to import click the button and confirm After you import last year s data you can edit that data and add more residents as needed To enter new resident data click the Add New Resident button located on the upper right side of the screen The resident information screen will be displayed Page 6 of 12 NJ Assisted Living Resident Profile Survey User Guide Assistec 7 Welcome Assisted Living Professional The New Jersey Department of Health Division of Health Facilities Evaluation and Licensing Assisted Living Residence and Comprehensive Personal Care Home Resident Profile Survey Resident Information Demographic Resident Identifier Print Gender Mase Female Medecaid Status Yes No Date of Birth mmviddtyyyy Date of Admission mmiddiyyyy Admission Source Respde Status Respite Non Flespite Crscharged Discharged In House ADL Medication Cognitive Impairment Please enter one of the following codes to identify each resident s need for assistance Independant Resident needs no assistance in performing the activity 1 Limited Resident needs some assistance in performing the activity 2 Total Resident is totally dependent upon others for the activity Dressing 9102 Bathing 9102 Toilet Use 918 Transfer 05102 Locomotion 98102 Bed Mobility 9910 Cognitive Skills nakl oF Resident Contractual Information Residen
5. NJ Assisted Living Resident Profile Survey User Guide NJ Health New Jersey Department of Health MSNA OG Oo aes ge tins E cue veve sae vesueaossic cca ser ese pee suse gascesaeuesc oun deemenuee pose E N deeacesee 2 De SCU Ad A COCSS aeee an nE E A E EE A E E EE 2 Da EC DO e E E E E E E EE rete gatraneaesdienesendens 2 2 2 ACCOUN Usernames and Pass WOrdS sssrinin ET E N 2 Or SEE ARCS IS a E E E A E A E E 4 I Fau POC AM OF MAIO scart e sae diansnesote te csanseutyecdeaidavanseecettsesansanseatmecdseonss 4 Ba Resident M Orma ON sorsien ie E sates ORERE E NEE EAEE E EE EEA AAE E EEA 6 PLAIN RESTE a E E E E E A 6 4 2 Selecting Residents Tor Edini seseina E EE EE E E E E 7 4 3 Respite Versus NOM INC S01 ae serccccteassensncinrenetesitecasscanscesesesseusnetestetevike E AE r E aeria SEN Ea saeeaesaets 8 4 4 In House Versus Discharged RESIGNS vcccc essxtsciscrnsncnsoniavetienssvcevsursesiueensvcaseusatetiendaveasbaxseaasannevcasentetedannes 9 Bi Pantabie intial Works heols aerodino n Ea E n EE OEE Er 10 4O Resident Contractual Iniormat OM ssis a E 11 4 7 In Process Versus Complete Status ccccccccccccccccccsssssseecececeeeaeeseceeeeeesaeeseeeeeeeeesseeeesseeeeeeeessasaaaneeseeess 11 J Resident Iniormaon REPOT esrar a a E E E E e a 11 6 Data Submission to the NJ Department of Health 0snnnennenssssseennssssssssserrssssssssseersssssssseereesssssssseeeeesssssseee 12 T eC MIG al SU PO ANG Help eresse E a Eea 12 Mm ne JERSEY HO
6. Residence and Comprehensive Personal Care Home Resident Profile Survey Information Submission Facility Name Assisted Living Residence SUBMIT SURVEY INFORMATION Note The survey can only be submitted once all resident data is set to Complete see Section 4 7 7 Technical Support and Help If you need technical assistance please contact NJHA Technical Support at alsurvey njha com 800 828 9366 or 609 275 4221 Page 12 of 12
7. SPITAL ASSOCIATION ON CadingAge zs JHA New Jersey H C ANJ formerly NJAHSA Page 1 of 12 NJ Assisted Living Resident Profile Survey User Guide 1 Introduction Welcome to the electronic New Jersey Department of Health Assisted Living Resident Profile Survey ALRPS The ALRPS tool may be accessed at https www njalsurvey com Through a unique partnership between the New Jersey DOH and the associations that represent assisted living in New Jersey the Health Care Association of New Jersey HCANJ the New Jersey Hospital Association NJHA and Leading Age New Jersey formerly the New Jersey Association of Homes and Services for the Aging NJHA s Department of Information Technology has transformed the paper based Assisted Living Resident Profile Survey into an Internet based tool that is easy to use and provides DOH and the field with more timely and accurate analysis of the data submitted All of this is at no cost to providers because of the financial commitment made by the associations to this important initiative HCANJ NJHA Leading Age New Jersey and DOH all look forward to continuing to work with assisted living providers to produce a timely meaningful and useful data report as a result of your mandatory data submissions on an annual basis We welcome your feedback on the Internet based Assisted Living Resident Profile Survey tool NI JIES ITAL ARANAIS CadingAge LS wy JHA New Jersey HC ANJ rman hy NAHEA 2 Sec
8. c 31 only 4 7 In Process Versus Complete Status When saving resident data there is an option for Complete Status Select In Process if only the demographic information has been entered Select Complete if all data has been entered 1 e demographic clinical and in house discharged information Complete Status In Process Complete Save Cancel Note In order to submit the completed survey in its entirety see Section 6 for full instructions all residents must be set to Complete status Resident ID Gender Medicaid Status DateofBirth AdmissionDate Respite Status Discharged Adminission Source View 444 Male Yes 10 19 1931 01 22 2007 No In House Nursing Home Q Delete View 445 Male Yes 04 12 1932 03 12 2009 No In House Nursing Home o Delete View 446 Female No 05 20 1930 05 13 2008 No Discharged Subacute Units Delete On the Resident Profile page the Complete Status column will show a red x BD for In Process and a green check BD for Complete Filter by status In process Completed Both The filter option on the Resident Profile page will allow you to view residents that are currently In process residents that are Completed or both in process and completed 5 Resident Information Report The Resident Information Report lists all the information entered into the ALRPS System This report is available by clicking the Resident Report button on the Resident Informa
9. formaGon The New Jersey Department of Health Division of Health Facilities Evaluation and Licensing Assisted Living Residence and Comprehensive Personal Care Home Resident Profile Survey Change Personal Information The following is a sei of requirements that each password must contain to ensure maximum secunty Earth password musi be at least 9 characters The password mugi contain ai least one upper case alpha character and one lower case alpha character These Passos ane case sensie The password mus contan ai least ore numene character 0 9 The password musi contain al lessi one special character Examples Ge SHES ee gt 2 Please enter a new password and enter your secunty question and answer to continue Cid Password New Password Confirm Password Securty Question Secunty Answer Confinn Securty Answer Cancel Page 3 of 12 NJ Assisted Living Resident Profile Survey User Guide At any time a user can request to have a password reset by contacting the NJ DOH via email at Andrew Benesch doh state nj us NJ DOH will reset the password with a system generated password The user will be required to change the password once they log back 1n to the website 3 User Registration At the beginning of each ALRPS year the NJ DOH will send an introductory email to all providers already registered in the ALRPS system Providers are required to review this email and reply with a confirmation that the informatio
10. iet Datars Oa Die hear ed Cane F eval Pe hia es MOT Gooe Subacute Linas Cescharged a T D si Lisia Tet eo Home imina C ti b oy Fermas Cot 12ST Reskhendad Meath Care Faoi Hic ee v To edit the resident s data click the Edit at the bottom of the screen Once all the changes have been made click the Update button to save this information To print an individual resident profile click Print at the top right of the screen The New Jersey Department of Health Division of Health Facilities Evaluation and Licensing Assisted Living Residence and Comprehensive Personal Care Home Resident Profile Survey Resident Information Demographic Riesadent identifier Gender Mae Female Medtaid Status yes No Date of Birth immiddiyyyy Date of Admission mnvddiyyyy Admission Source Respite Status Respite Non Respite Discharged Discharged In House ADLMedicatonm Cognitive impairment Please enter one of the following codes to entity each residents need for assistance O In Resident needs no assistance in performing the activity 7 Limie Repani mids some a6cisiance in performing te actly 2 Total Messicani is totally dependent upon ofhers for fee activity Dressing 190102 mhn 0002 Taletu gM1O2 Tane 9122 Locomation 9 1 2 Ba Moy 90102 Eating 98102 Med Admin Status 912 Cognitive Skils gM 1S 2 Resident Contractual Information Resident had a heaith service pla
11. ing Professonal Ill AspstedlivingProdnhs com To edit the information listed click the Edit button at the bottom of the screen After editing the information click the Update button to commit the entered changes Any information entered into the ALRP Survey System is saved but is not made available to the NJ DOH until it is formally submitted as outlined in section 6 of this manual Page 5 of 12 NJ Assisted Living Resident Profile Survey User Guide 4 Resident Information The ALRPS System is designed to enter edit print and submit resident information Unlike the paper or Excel worksheet collection methods of the past the electronic resident information collection leverages workflow and logic to streamline the resident information collection process 4 1 Adding Residents The first time a user logs into the ALRPS System the Resident Profile screen will either be blank or have an import button available If a survey was submitted via the website the previous year then the previous year s resident data can be imported for this year s survey No resident data has been entered yet Please click Add New Resident button to add data Or click the Import button below to import the resident data from last year Note The import option is only available until new residents are added a warning is shown if you click Add New Resident Windows Internet Explorer Once anew resident is added you can no longer import
12. n as of 12 317 Ove O Mo Resident had a managed risk agreement as of 12 31 Yes No Compete Status SinFrocess Complete Cancel 4 3 Respite Versus Non Respite For In House residents the Respite Status radio button determines if spouse information is required The Lives with Spouse question is activated for Non Respite residents only The question will not appear for Respite residents since it is not required Respite Status Respite Non Respite Discharged In House AQDL Medicaton Cognitive Impairment O Discharged In House Pl ase enter one ofthe following codes to idg ntity each residents need for assistance O Independent Resident needs ng assistance in peronming the activity e 1 Limited Resident needs some gssistance in pecorming the activity 2 ToOtal Resident is totally dependent upon others for the actrity Dressing Mo M1O2 Bathing M0102 Toilet Use O00102 Transfer O00102 Locomotion Mo O1 02 Bed Mobility Go1O02 Eating MoO1O2 MedAdmin Status 99942 Cognitive Skills 0001 O2 Resident lives with spouse in the facility Yes No Page 8 of 12 NJ Assisted Living Resident Profile Survey User Guide Note For Respite residents a warning will be shown if the discharge date is over 60 days from the admission date If the resident is In House and the admission date is over 60 days from the current date the same warning is shown Click OK to accept the date you entered as c
13. n is correct or provide any updates or corrections New providers must submit an ALRPS Registration Form which may be accessed at https www njalsurvey com This form collects facility information required by the survey and includes the administrator and contact information Once this information is received a confirmation email is sent to each new registered user It is recommended that each facility have at least two users registered one administrator and one survey contact All users are required to have a PC with access to the Internet Internet Explorer version 7 is the standard supported browser MAC browsers are not supported at this time 3 1 Facility Profile Information Facility Administrator and Contact Based on the provider s response to the introductory email or the ALRPS Registration form information is pre loaded for each facility This information which includes the contact information for the facility the administrator and survey contact should be verified to ensure accuracy Special Resident Services This section asks the user to indicate if Alzheimer s and other special services including respite hospice and behavior management are offered An option for other is also provided If other is selected the user is required to type a description of the service If respite is selected the Respite Status field for each resident must be completed in the Resident Information screens If respite
14. orrect or Cancel to clear your entry Windows Internet Explorer k P For respite patient the length of stay should be less than 60 days Are vou sure this is correct i Cancel 4 4 In House Versus Discharged Residents The resident information screen collects different information depending on the resident s status as In House or Discharged The In House and Discharged radio buttons change the information collection requirement automatically For In House residents the ADL Medication Cognitive Impairment section is activated for collection Demographic Resident Identifier Medicaid Status Gender Male Female Date of Birth mmiddlyyyy Date of Admission Admission Source ADL Medication Cognitive Impairment Please enter one of the following codes to identify each resident s need for assistance 0 Independent Resident needs no assistance in performing the activity 1 Limited Resident needs some assistance in performing the activity 2 Total Resident is totally dependent upon others for the activity Dressing 0100102 Bathing Toilet Use 0 1 P Transfer Locomotion 0 4 2 Bed Mobility Eating 0 1 3 Med Admin Status Cognitive Skills 0 1 4 Resident Contractual Information Resident had a health service plan as of 12 31 Yes No Resident had a managed risk agreement as of 12 31 Yes No Complete Status In Process Complete Save _ Cancel Print es No
15. t had a heath senice plan as of 12317 Wes No Resident had a managed risk agreement as of 12131 Yes No Complete Status In Process Complete K Once the information has been entered click the Save button at the bottom of the screen and all the resident information will be saved to the system To add another resident s information click the Add New Resident button located at the top right of the screen Once a new resident record has been saved it will appear on the resident information list screen You will notice a question mark next to the cursor when you pass over each data element Simply leave your mouse on the data label and the description explaining the required information will appear Demographic Resident Identifier Resident Identification Number To ensure confidentiality WOU must use a generic identifier such as 1 2 3 4 for each Medicaid Status O Yes No resident DO NOT use resident name E ido te maere eT Date of Admission rmiddiyyyy E Respite Status Respite Non Respite Discharged Discharged In House 4 2 Selecting Residents for Editing After the initial user login the first screen displayed is the Resident Information Screen It will contain a list of all residents entered for the current reporting year To edit any resident s profile select the Edit link to the left of the Resident ID Page 7 of 12 NJ Assisted Living Resident Profile Survey User Guide Acsarte Comi P
16. tem also requires that each user maintain a valid password and it requires each user to change their system assigned password the first time they log in Additional security features have been implemented to require users to change their passwords at a pre determined time frame This means that users may be asked to select a new password each year ALRPS administrators have the ability to force all users to change their password regardless of the last time it was changed The following is a set of requirements that each password must contain to ensure maximum security e Each password must be at least 8 characters e The password must contain at least one upper case alpha character and one lower case alpha character These passwords are case sensitive e The password must contain at least one numeric character 0 9 e The password must contain at least one special character Examples amp lt gt Below are some examples of valid passwords P ssword1945 Racecar 88 CampSouth amp 9 At any time a user can change a current password by clicking the Change Personal Information link on the main tool bar at the top of the screen This will bring up the change password screen and prompt users to enter their current password and enter their new password The system requires users to enter the new password twice to ensure there are no typos Assist s li Welcome Assisted Living Professional rater Change Personal in
17. tion screen All facility information is also included on this report The New Jersey Department of Health Division of Health Facilities Evaluation ang Licensing Assisted Living Residence and Comprehensive Personal Care Home Resident Profile Survey Resident Information Facility Name Assisted Living Residence Add New Resident Resident Report Printable Worksheets Total residents listed 5 Fiter by status in process Completed Both complete Status b cs Femaia No Coe 86S Home Ho In House B U ih cs wate Yes DAONA OLDIRDI Home Ho In House E tk hy cs Female No C6094 O402011 Nursing Home No In House x tk Be cs Faemais No COTS 1A012013 Residential Hean Care Faciity HO In House is Page 11 of 12 NJ Assisted Living Resident Profile Survey User Guide 6 Data Submission to the NJ Department of Health The ALRPS System is designed to provide an active work space for assisted living facilities assisted living programs and comprehensive personal care homes to compile the yearly Assisted Living Survey data Once a provider feels satisfied that all the required information is complete and accurate final data may be submitted to the NJ DOH The ALRPS System will send an email to the provider confirming submission amp Assist 0 7 l Welcome Assisted Living Professional ty Profile Submit Survey New Jersey Department of Health Divisiopof Health Facilities Evaluation and Licensing Assisted Livigg
18. ult of user feedback The worksheet is provided as a matter of convenience for those users who have entered resident demographic information and wish to forward the worksheet to clinical staff to expedite collection of ADL data By clicking the Printable Worksheets button located at the top of the Resident Information screen the user will be able to generate a report of all in process resident profiles The report will list the resident identifier and blank ADL data fields for completion The New Jersey Department of Health Division of Health Facilities Evaluation and Licensing Assisted Living Residence and Comprehensive Personal Care Home Resident Profile Survey if Resident Information a Faciity Name Assisted Living Residence New Resident Resident Report Printable Worksheets Total residents listed 5 Filler by siatus C In process O Completed Both hy cs Female No 0101960 0101 2013 Home No In House 8 i B cst Male Yes O807 1941 4 01 2012 Home No In House E w Be cs Female No DOANG O406 2011 Nursing Home No In House i By esa Female No CAOT 12012013 Residential Health Care Facility Ho In House 8 Ta Page 10 of 12 NJ Assisted Living Resident Profile Survey User Guide 4 6 Resident Contractual Information This section asks users to indicate whether each resident had a health service plan or managed risk agreement on December 31 last day of the reporting year Please note that this question is specific to De
19. urity and Access To ensure optimal system security and data integrity the ALRPS System utilizes various industry standard techniques for using the Internet safely and efficiently Since the Internet is a free network medium the ALRPS System uses password protection and encrypts the data during each session 2 1 Data Encryption The ALRPS System uses secured socket layering which is an industry standard 128 bit data encryption protocol that all Internet banking systems deploy to protect account and web session information While logged on and using the ALRPS System all data displayed on the user screens and submitted via the user s browser to and from the ALRPS System servers is encrypted to prevent data monitoring or unauthorized copying 2 2 Account Usernames and Passwords Each account username is password protected to prevent unauthorized access The account name is set to the email address This ensures that a valid email address is available for each user Each user is responsible for reporting any Page 2 of 12 NJ Assisted Living Resident Profile Survey User Guide changes to their email address by either updating the ALRPS System facility information or contacting NJ DOH to provide an updated email address The ALRPS System will use valid email addresses to send important information to all users Without a valid email address for each user the system will not be able to send important information or confirm submissions The sys
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