ASPEN 11.2 Updates - surveyor-training...

LTCSP

ASPEN 11.2 Updates

LTCSP 1

Presenter

Presentation Notes

This is [Synora Jones] from CMS and myself and [Kellie Jakaitis] will be doing the training. The goal of today’s presentation is to cover the changes to ASPEN 11.2. In addition, we will highlight some of the areas that surveyors have asked about or have been struggling with.

Updated LTCSP PG

LTCSP 2

Presenter

Presentation Notes

There is an updated LTCSP Procedure Guide. For this presentation, I will first show the changes made to the tool using a training survey. At the end of the presentation we will discuss the changes to the Procedure Guide. During this training, we will tell you which step in the Procedure Guide we are covering so you can take notes if you’d like. However, we would really like for you to watch the screen as I demonstrate the changes.

Initial Pool Workload

LTCSP 24

Presenter

Presentation Notes

Turn to Step 12 in the Procedure Guide. I first want to clarify a few areas regarding the initial pool process. The first area we want to discuss is the initial pool workload. Attachment A in the Procedure Guide has been updated and now shows the expected initial pool size according to the recommended survey team size. If the recommended survey team size is four surveyors, then each surveyor is expected to have about eight residents in their initial pool, which results in an initial pool of about 32 residents across the survey team. If a State decides to send more than the recommended number of surveyors on a survey, then it is acceptable for the team to split unit assignments and distribute the expected initial pool size across the larger team. For example, if a State sends a team of six surveyors when the recommendation is four surveyors, then the expected initial pool size remains 32 residents. These residents can be distributed across the team which means four of the six surveyors will have about five residents in their initial pool and the other two surveyors will have about six residents in their initial pool). If a State sends fewer than the recommended number of surveyors, the smaller team also must adjust their initial pool numbers. For example, if a State sends three surveyors when the recommendation is four surveyors, then the three surveyors must still include about 32 initial pool residents across the team, or two surveyors with about 11 initial pool residents and one surveyor with about 10 initial pool residents.

Screening

• Identify onsite selected residents• Review MDS indicators and matrix• Brief

– Quick head-to-toe observation– High level questions

• No screening questions or tool

LTCSP 25

Presenter

Presentation Notes

Now let’s clarify the screening process. The purpose of briefly screening all residents in your assigned area is to identify residents to include in the initial pool. All offsite selected residents (unless discharged) and any complaint/FRI residents (maximum of five) are to be included in the initial pool, and therefore do not need to be screened. You will screen all other residents to determine if they should be in the initial pool. Before you enter each room, review the MDS indicators and matrix information (if available) for the residents you will be screening in the room to give you a more complete picture. You also will know ahead if they are newly admitted residents. If you have no concerns based on the MDS indicators and matrix information, conduct a quick head-to-toe observation of the resident. If you don’t have any observation concerns, move on. If you identify a concern during your quick observation such as staff ignoring a resident yelling out in pain or a resident who has facial bruising OR if you have a concern based on your review of the MDS indicators or matrix, introduce yourself and ask a few high level questions – like How long have you lived here? Do you have any concerns with your care? and then ask the resident about your identified concern to help decide if the resident should be included in the initial pool. Interactions should be quick to allow time to complete full interviews and observations with initial pool residents. There are no initial screening questions or screening tool included in the system. Conduct the screening based on your knowledge and critical thinking skills. Here are two examples for the brief screening: Resident A has an MDS indicator for depression and no other MDS indicators. The matrix shows the resident is receiving an antidepressant. I observe the resident in her room, well groomed, dressed appropriately, and playing cards. I have no observation concerns. My screening is complete and I would not include this resident in the initial pool. Resident B, who is not vulnerable, new admission, offsite selected or complaint, has an MDS indicator for weight loss. I have not received the matrix yet. The resident is in her room at 8:30 am with her breakfast meal on the over-the-bed table. The resident consumed 100% of her breakfast. After introducing myself, I ask a few high level questions (e.g., do you have any concerns?). I would then ask about the food and weight loss. The resident says she likes the food. The resident says she had a cold and lost her appetite a couple months back but has gained the weight back. My screening is complete after a couple of minutes and I would not include this resident in the initial pool.

Screening, Cont.

• No required documentation• If doc, use Surveyor Notes• Do not document screening results

on RI, RO, RR • No interview status or assignment• Copy Surveyor Notes if decide to

include resident in initial pool

LTCSP 26

Presenter

Presentation Notes

You are not required to document the results of your screening. However, if you would like to document your screening results or take notes for the residents in your assigned area to help keep you organized, document these notes under Surveyor Notes. Do not document your screening results on the RI, RO, RR screens or mark the Complete box for any resident who isn’t a part of the initial pool. You should not be completing the RI, RRI, RO, or RR areas when screening – these are to be completed only for residents that are included in the initial pool. Do not enter an interview status for any resident not included in the initial pool. Ensure you are not assigned to any resident who is not included in the initial pool. If you determine that one of the residents you have screened will be in the initial pool and you have notes in the Surveyor Notes section, you can copy and paste those notes into the correct Initial Pool Care Area.

Initial Pool Residents

• Assigned• Subgroup• Interview Status • Completed RI/RRI, RO, and RR

screens• Confirm initial pool on team meeting

screen

LTCSP 27

Presenter

Presentation Notes

We wanted to ensure it was clear what areas you should complete for your initial pool residents. If you are assigned to a resident, that means the resident is included in the initial pool. If you pre-assign yourself to all residents before screening – ensure you remember to remove your assignment once you know the resident will not be a part of the initial pool. For every initial pool resident, remember to select at least one subgroup and an interview status. You should answer every initial pool area listed under the interview, observation, and record review sources. We have found quite a few areas left blank with or without the complete box being checked. The only acceptable reason you should mark the Complete box is if a resident halts an interview and you are unable to complete the interview. When the team meets, the TC should confirm the accuracy of the initial pool on the team meeting screen under the section titled “How many residents did each surveyor include in the initial pool?” If a resident shouldn’t be listed, the surveyor should remove their assignment on the Resident Manager screen to remove the resident from the initial pool.

Complaint During Initial Pool

• Include if fewer than five residents • Enough time to complete• Attach the complaint to the shell• Import the shell • Say No to warning message (do not

overwrite data)• Complete Offsite Prep for the complaint• Share data

LTCSP 33

Presenter

Presentation Notes

If a complaint is called into the State Agency and added to the survey during the initial pool process, the team should discuss whether to include the complaint resident in the initial pool as long as there are fewer than five complaint/FRI residents and there is enough time left in the initial pool to complete the interview, observation and record review. To include the complaint resident in the initial pool: The SA should attach the complaint to the survey shell. Everyone should re-import the shell and answer No to the warning message (do not overwrite the data) so only complaints are updated. Then you will complete the complaint steps on the Offsite Prep screen and share the data with the team. This method is preferable to just adding the complaint or FRI subgroup on the Resident Manager screen. If you just add the complaint/FRI subgroup on the Resident Manager screen the system won’t know which areas are associated with the allegations. Knowing the specific complaint areas is important since the system will now ensure you have sampled adequately for each complaint area.

LTCSP 50

Presenter

Presentation Notes

There was one change made to the Resident Assessment task regarding residents who are getting selected who have an MDS greater than 120 days from when the survey shell was exported. We are now excluding residents who have a death and admission assessment that occurred on same day. The residents being selected are because the resident has not had an admission, quarterly, annual, or significant change assessment in the last 120 days. We know that the system is inappropriately selecting residents who had a discharge as their most recent assessment. That change has not been made yet. If you find that one of the residents was discharged and there weren’t any issues with any other residents related to this task, you can simply answer the CEs as Yes. OR If the only reason this task was triggered was because of an inappropriately selected resident, you may remove the task.

Beneficiary Notices Pathway

• Five denial letters removed• Use CMS-10055 for SNF ABN• Table updates

– First two scenarios do not apply for NOMNC if beneficiary initiated discharge

– Third scenario regarding hospice –now notice not required

LTCSP 51

Presenter

Presentation Notes

Let’s discus the changes made to the Beneficiary Notices pathway. Reference to the five denial letters was removed. The facility should only use the form referenced in the pathway. There were also a few changes made to the table.

Extended Survey Pathway

• Info reorganized • CE11 and 12 – N/A unless pending

facility closure• Removed PBJ• Added Training Requirements

– F943 (Abuse)– F947 (Nurse Aides)– F948 (Feeding Assistants)

LTCSP 52

Presenter

Presentation Notes

Some of the information was rearranged on the Extended pathway. We added a clarification statement to CE11 and CE12 that those two CEs should only be answered as Yes or No if there was a pending closure. The payroll-based journal tag was removed. Three new tags were added to cover the training requirements. That’s it for the changes made to the facility task pathways. Now let’s move on to the changes made to the Closed Record Sample screen.

Resident Investigation Doc

• Two options– Investigation Notes are specific to the

care area, includes initial pool notes– Resident Notes is general information

that is copied across all care areas for the resident

LTCSP 56

Presenter

Presentation Notes

I just wanted to ensure everyone understand the two ways to document your investigation: You may use the Investigation Notes field to document any information specific to the care area being investigated (e.g., observations, interviews, specific record review such as relevant MDS information, care plan, or physician orders). Any notes entered during the initial pool process will be displayed in the investigation notes. You may use the Resident Notes field to document any general information about the resident that you would like to have access to for all care areas (e.g., diagnoses, BIMS, general MDS information regarding cognition and ADL status, and general care plan information. Either documentation option is acceptable. Resident Notes may be a more efficient option to document your information during your investigation since your documentation is one continuous notes field; however, you may spend more time editing your documentation for the CMS-2567. Using Investigation Notes will have the reverse pros and cons as Resident Notes.

CE Pathway Updates

• Death– Added Advance Directives and F678

(CPR) to the list of other areas to consider

• Positioning, Mobility, ROM– Added an NA option to CE2 if there

were no positioning concerns

LTCSP 59

Presenter

Presentation Notes

There were two CE pathway changes. The first change was to the death pathway. We added Advance Directives and F678 (CPR) to the list of other areas to consider at the bottom of the pathway. The second change was to the positioning, mobility, and ROM pathway. We added an NA option to CE2 which you can now mark if there were no positioning concerns for the resident. That concludes the changes made to the Investigation screen.

LTCSP 64

Presenter

Presentation Notes

Once investigations are completed and everyone shares their data with the TC, the TC should also verify the combined med error rate is consistent with the response for CE1 which is the med error rate CE. If the error rate is less than 5% but a surveyor marked CE1 as No, do not cite the tag during the potential citation meeting. If the error rate is 5% or greater but CE1 is not marked as No, update the response for CE1 prior to the potential citation meeting.

Universe

LTCSP 68

Presenter

Presentation Notes

We have received a number of questions regarding how to determine the universe. The universe is the number of residents investigated for each care area as noted on the Sample Finalization screen – by Care Area option. As an example, we are citing one resident for falls. The universe for the tag would be 1 of 2 sampled residents.

Updated Forms

• Facility Matrix– Abbreviations for PU and TF– Falls– Dehydration

• Entrance– Removed variances: Below ground

level, window to outside, direct access to exit

LTCSP 70

Presenter

Presentation Notes

There were a few changes made to the facility matrix. We added new abbreviations that the facility can use for the pressure ulcer and tube feeding areas. For falls, we clarified that the facility should identify any resident who has fallen in the facility in the last 90 days. If the resident hasn’t been in the facility for 90 days it’ll be since their admission. For dehydration, we removed the examples. The focus should be on anyone who has actual hydration concerns. We removed three variances from the Entrance Conference worksheet since they no longer apply. We removed the variance for below ground level, no window to the outside, and no direct access to an exit corridor.

Updated LTCSP Reports

• Initial Pool Report– No subgroup, but assigned– Triggered tasks – Discharged offsite selected residents

• Surveyor Workload Report – Facility Tasks– Initial pool area (fall, smoking instead

of accidents)LTCSP 71

Presenter

Presentation Notes

Let me cover the changes made to three reports included within the LTCSP system. Initial Pool Report will list: Any resident who was assigned to a surveyor but didn’t have a subgroup. Triggered facility tasks and resident names. Any discharged offsite selected resident and the discharge location. Surveyor Workload Report will list: Facility task info such as resident names reviewed. The initial pool area such as edema, skin conditions, falls, or smoking instead of the investigation area like general or accidents.

Updated LTCSP Reports, Cont.

• Investigation Report– Doc for Other Concerns

• MDS Indicator Facility Rate Report– Indicator descriptions updated

LTCSP 72

Presenter

Presentation Notes

Investigation Report will list: Documentation if the surveyor marked FI for Other Concerns on the RI/RO/RR screens. The description for the indicators have been updated on the MDS Indicator Facility Rate Report.

LTCSP 73

Presenter

Presentation Notes

This release also includes the ability to review and print all of the survey documentation in ACO. There are many different sort and filter options available depending on what type of documentation you need to access.

LTCSP PG – Table of Contents

LTCSP 74

Presenter

Presentation Notes

The LTCSP Procedure Guide has undergone extensive revisions so we continue to advise everyone refer to the Procedure Guide during the survey. To wrap up, I want to summarize the major changes made to the Procedure Guide. We have added a table of contents and now you can easily navigate around the Procedure Guide using a bookmark feature.

LTCSP PG – Step 1

LTCSP 75

Presenter

Presentation Notes

We added how to create a team in ACO to Step 1 since the team is encouraged to add the team in ACO. We’ve also included instructions for how to handle technical issues. We’ve provided the QTSO Help Desk number for immediate concerns and instructions for creating screen shots with a description of the technical issue.

LTCSP PG – Step 5

LTCSP 76

Presenter

Presentation Notes

For Step 5, we have included the other way you can use to access the LTCSP survey which is to right click on the Event ID in ASE-Q and select LTCSP from the drop down menu. If you get a warning when you try to access the survey that says the system is unable to connect to the server, if you just click on the LTCSP button again, you will be able to access the survey.

LTCSP PG – Step 6

LTCSP 77

Presenter

Presentation Notes

Step 6 now includes all of the new complaint and FRI features included during offsite prep. Assigning the complaints and FRIs was removed from Step 7 since they are now assigned during offsite prep.

LTCSP PG – Step 10

LTCSP 78

Presenter

Presentation Notes

Step 10 now explains that during the survey, the team should only be sharing data within the LTCSP survey. Surveyors should not export and import the survey shell in ASE-Q unless the team composition has changed and a new surveyor has been added to the team.


LTCSP 79

Presenter

Presentation Notes

For Step 11, we’ve added a recommendation for the team to bring a power strip with surge protector for use onsite as needed. You should not use an extension cord with the surge protector.


LTCSP 80

Presenter

Presentation Notes

We’ve added instructions to Step 12 for how the time works on the Entrance Conference screen. The first time you click on the Entrance Conference screen, the date and time will populate at the top of the screen. If you click on the Set button the time will reflect the current date and time which cannot be changed. There is also a reminder that if you are assigned to the kitchen task, it is recommended to use the pathway instead of the probes on the screen since they may not be paired correctly with the CEs.

LTCSP PG – Step 13 (Initial Pool)

LTCSP 81

• Workload• Screening• Complaint• Search for a resident to avoid

duplication• Identified Concern subgroup• Sharing a resident

Presenter

Presentation Notes

There were a number of changes made to Step 13. The initial pool workload description was moved to the beginning of this section. The initial pool workload outlines the number of initial pool residents per surveyor which may change depending on whether the team size is greater or fewer than the number of surveyors that is recommended. We have also teased out screening of residents and added a lot of description regarding how the screening should be conducted which we discussed earlier. We added instructions for how to handle complaints called in during the initial pool. While we made other changes throughout this step, I’m only going to mention a few other major changes. When you are reviewing residents in your assigned area and you do not see the resident’s name in the system ensure you search for the resident to avoid duplicating the resident’s name. If you accidently duplicate a resident’s name you cannot remove the name you added. In that case, you should use the system populated name since that name may have MDS indicator information. I want to ensure we are all on the same page when to use the Identified Concern subgroup for an initial pool resident. The identified concern subgroup should only be used for a resident who isn’t vulnerable, newly admitted, complaint, FRI or offsite selected. You should not use the identified concern subgroup if a resident in the initial pool has expressed a concern. Those concerns will be noted with an FI for the applicable area. We clarified how to share workload during the initial pool. If two surveyors share an initial pool resident just realize the warning message the TC gets when the completed initial pool data is shared is related to the assignment of the resident. The message is asking, “Who should be assigned to the resident” – typically the assignment will stay with the initial surveyor. When residents are shared, all initial pool notes will merge and any FI response will override a response of No Issue.


LTCSP 82

Presenter

Presentation Notes

We moved the team composition change instructions from the data sharing step to Step 14 which covers data sharing at the end of each day and team composition changes.


LTCSP 83

Presenter

Presentation Notes

We’ve added a reminder to Step 16 that the TC should confirm the initial pool data is complete.


LTCSP 84

Presenter

Presentation Notes

For Step 17, we moved updating the facility census number to before starting the sample meeting. We’ve updated the sample selection instructions to include the new complaint/FRI features, how to remove a discharged unnecessary med resident, and how to refresh the screen before the sample is finalized.


LTCSP 85

Presenter

Presentation Notes

Step 18 was updated to reflect the new complaint/FRI changes made to the investigation screen and the instructions for how to handle a complaint called in during the investigation portion of the survey. We also added instructions for the new feature to edit your investigative documentation prior to the potential citation meeting. We also explained that if you try to add a care area or tag but it isn’t listed on the initiation screen that means the area already exists on the Investigation screen and cannot be initiated again. We stressed that if you share a resident or task in order to see the other surveyor’s documentation you have to change the filter on the screen to All Surveyors.


LTCSP 86

Presenter

Presentation Notes

For the facility task step 20, we added instructions that using ALT+R will include the resident on the sample list report for the facility – this applies to any notes field in the system, not just facility tasks. For dining, we explained why residents may appear in the resident box - if they had an MDS indicator of weight loss or dehydration or they had further investigate marked for nutrition, hydration or food quality. Clicking on the resident’s name will show the relevant interview notes. We added clarification that any initial pool resident who had FI marked for staffing, will be displayed in the resident box on the sufficient staffing screen once the sample is finalized. We added instructions for the applicable facility tasks explaining how to add a resident to the resident box. For environment, we clarified that it is up to the state whether the surveyors review emergency preparedness and oxygen. We also added Extended to the triggered task section.


LTCSP 87

Presenter

Presentation Notes

We’ve updated Step 23 so it now provides instructions for the team to share their completed investigation data with the TC and the TC is reminded to confirm all resident and facility task investigations have been completed. Step 23 was also updated so it now provides the instructions required to complete the potential citation meeting, including the new features regarding SQC and moving tags.


LTCSP 88

Presenter

Presentation Notes

We’ve included instructions for how to add residents to the sample list report for the facility in Step 24. We also clarified that you shouldn’t discuss tags unless the administrator requests that you give the tag number which is outlined in the S&C memo included in Step 24.


LTCSP 89

Presenter

Presentation Notes

For Step 25, we’ve ensured the steps are correct for how to load cites and how to handle the situation if errors are identified. We also provided instructions for how to handle the extended survey if SQC is cited and the team has to return to complete the extended.


LTCSP 90

Presenter

Presentation Notes

Step 26 now provides instructions for how to delete the completed survey once it is imported back to ACO.

LTCSP PG – Attachment A

LTCSP 91

Presenter

Presentation Notes

Attachment A was updated and now includes the approximate total number of initial pool residents for the team based on the recommended team size.

Questions

• Technical Questions Onsite– QTSO Help Desk – 1-888-477-7876

• Survey Process Questions– SA Trainer– RO Ambassador – CMS NH Survey Development

[email protected]

LTCSP 92

Presenter

Presentation Notes

If you are onsite and are having technical issues that your state cannot resolve, you should contact the QTSO Help Desk. The number is on the slide and is on the splash screen when you first log in to ASE-Q. If you need immediate assistance make sure you tell them you are onsite. If you identify technical issues with the software onsite, it is important that you report the issues to QTSO Help Desk so the issue can be addressed. It is helpful if you can take screen shots with a detailed explanation of the issue. If you have survey process questions contact the SA trainer or RO Ambassador. You should continue to send any survey process questions to the CMS nursing home survey development email.

mailto:[email protected]

Implementation

• 5/6/18 Roll-out Date• Survey Resource folder updated (e.g., Mapping,

Pathways, Forms)• Recorded training after 4/23/18• Q&A Sessions – info forthcoming for ROAs and

Branch Managershttps://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

LTCSP 93

Presenter

Presentation Notes

Finally, the roll-out date is the weekend of 5/6; however, the auto update will be available the evening of 5/4. You should download a new version of the LTCSP Survey Resource folder which has all updated forms, pathways and the mapping document and is posted on CMS’s website which is included on the slide. The recording of this training is on ISTW and will be available after April 23rd. There will be Q&A sessions for Regions and States – the information will be forthcoming to ROAs and Branch Managers.

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html

ASPEN 11.2 Updates - surveyor-training...

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