Application Submission Requirements (120 hour) Home Health Aide Training Program (HHP)
The following items must be submitted for application consideration:
Requests for initial approval of the 120 hour home health aide training program may be submitted by home health agencies, public education institutions and agencies. The requirements for home health aide training programs are found in Title 22, California Code of Regulations (CCR Section 74747), Code of Federal Regulation (CFR 484.36) and Health and Safety Code 1736.6(a)(4)(b). The basic training program for HHA certification requires a minimum of 120 hours of training.
Each applicant must submit a CDPH 191 Application for the 120 Hour Home Health Aide Training Program. The form must be complete and address all fields on the form. The person designated as RN Program Director for the HHA Training Program must have the same qualifications as an Instructor and must be approved as an Instructor prior to or concurrent with being designated as the RN Program Director for the training program. Additional forms and documents must accompany the application as listed.
This curriculum includes the five topics listed below required in accordance with state and federal regulations, including the minimum number of class hours and clinical practice hours. These topics are found at CCR, Title 22, Section 74747 and CFR, Section 484.36:
a) Introduction to the Aide and Agency Role
b) Interpretation of Medical and Social Needs of People Being Served
c) Personal Care Services
e) Cleaning and Care Tasks in the Home
Per federal regulations, 16 hours of federal classroom instruction must be provided prior to patient contact. These topics include: infection control, patient rights, communication, safety and emergency services, and promotion independence of patients. These topics can be taught separately as a sixth topic, or they may be included in the five topics above (a-e).
Total training may not be less than 120 hours. Classroom hours may not exceed 75 hours and the recommended minimum number of hours for clinical is 61 hours. Lab hours are recommended, but are not counted towards required hours. A copy of the 120 Hour Home Health Aide (HHA) Training Program Curriculum (CDPH 191A) outlines all components of classroom and clinical training, including assignments and methods of evaluating student learning (tests, skill demonstration, etc.).
One lesson plan for each of the five topics must be submitted. Each lesson plan must include student learning objectives, content outline, method of teaching and method of evaluation (testing).
Sample Student Record
Submit a copy of the forms that will be used to document and validate the classroom and clinical curriculum to include skill demonstration and evaluation. The student record will include the date and hours of instruction, date and skill of demonstration or evaluation, and the name of the instructor performing the skill evaluation. Records will be maintained for a four-year period, and will be made available to the Department for review upon request.
Each instructor must be approved by the Department prior to teaching. Previously approved instructors are required to submit a new application and obtain approval for each specific training program. HHA Instructors must be Registered Nurses (RNs) with at least two years of RN nursing experience, to include one year of employment by a Home Health Agency, providing direct patient care. Licensed Vocational Nurses (LVNs) are not eligible to be approved as HHA Training Program Instructors.
Each applicant must complete the CDPH 191B form and include a resume and copy of the active RN license with the application. The resume must include month/year to month/year of nursing experience, name, address, and phone number of employer and the name of the supervisor. Resumes that lack verifiable information will not be approved.
HHA Training Programs must provide clinical training for students in a health facility setting to ensure that students have the opportunity to practice and demonstrate nursing and home care skills with direct patient contact. The health facility types that are approved by the Department to be clinical sites are licensed as Home Health and Hospice Agencies, Acute Care Hospitals, and Skilled Nursing Facilities (SNF). The training focus shall be on delivery of care and services in the home environment, and not in an institutionalized setting. The clinical site facility must comply with state and federal regulations and must not have a Department imposed two year Training Program ban secondary to enforcement actions.
An applicant may choose to submit a Clinical site agreement other than the CDPH 276E clinical site agreement. If an alternate document is submitted, it must contain the following components:
- Separate responsibilities for the Training Program and the health facility.
- Include the name and address of the parties, and be signed by the facility administrator and training program Owner or Administrator.
- The agreement must be a closed-ended contract with a specific expiration date of two years or less.
- Both parties must agree to follow all local, state and federal laws and regulations.
- The training program (school) must be responsible for all training in its entirety and cannot allow facility staff to train, teach, monitor, shadow, or proctor students. The Department approved RN Instructor(s) must provide direct and immediate supervision of the students at all times.
- Skills must be performed on residents in the clinical setting, evaluated by the Instructor, and then recorded on the student record.
- The school must work collaboratively with the facility to establish a clinical schedule that includes specific training dates and times.
- The school must provide the facility with a list of student names and training schedule which indicates dates and times of training.
- The school will ensure that the students have had the following, prior to direct care in the clinical setting:
- Criminal screening which must be completed upon student enrollment.
- Physical examination to include tuberculin (TB} skin test (PPD) or chest x-ray.
- Examination results signed by the individual doing the examination. Results must indicate that the student does not have any health condition that would interfere with the students' ability to perform care duties, and that the student is free from signs and symptoms of infectious disease.
It is the responsibility of the school to provide documentation that the students in the clinical setting do not pose a health risk to patients/residents. The Training Program must supply a list of student names to the facilities that have met the above criteria.
Policy and Procedures Manual
Each applicant must develop and submit a policy and procedure manual that details the administrative and management policies (rules) governing the program. The manual is to be written for HHP employees in order to inform them of the rules governing the HHP. Each policy should include a policy statement, purpose statement, scope, responsibility statement and specific procedure steps. Procedural steps must include sufficient detail and identify who, what, when, were and how each step will be carried out. Policies covering each of the following categories should be included:
- Staffing - Job Descriptions, qualifications and duties for all HHP staff must be included. Each HHP must include information for the RN Program Director, HHP Instructor, and program Administrator/Owner roles. Indicate HHP Instructor and RN Program Director qualifications, approval process and license requirements.
- Organizational Chart - This policy should include information on how the organization chart will be developed and updated. Who will make updates and when. Describe the revision process. The organizational chart must be submitted with this policy and must indicate lines of authority. Job titles on the organizational chart must match job titles listed in P&P and include Administrator/Owner, RN Program Director and Instructor job titles.
- School Advertising - The policy must include a statement that a NATP shall not make false or misleading claims or advertisements regarding training. Include the person responsible for monitoring and compliance of advertising. Describe how and when monitoring is to be performed.
- Student Enrollment – P&P must detail initial application process at time of enrollment, including submission of CDPH 283D HHA application form and Live Scan BCIA8016 form to the Department's Aide & Technician Certification Section Registry upon student enrollment. The criminal background clearance requirement and process must be addressed. Include requirement for all students to complete Live Scan fingerprinting upon enrollment and prior to beginning clinical training or direct contact with patients. The Health requirements for physical examination and tuberculosis testing process must be included. A determination that the individual is free of active tuberculosis disease per tuberculin infection must be made using testing method(s) recommended by the Federal Centers for Disease Control and Prevention (CDC) and licensed by the federal Food and Drug Administration (FDA).
- Training Requirements - Ensure that the Training Program will meet all federal and state requirements regarding curriculum, clinical topics and required hours of training. All theory classroom training must be completed prior to the clinical instruction for that topic being taught. All clinical training must be completed at the Department approved clinical training facility. P&P to include the clinical training site approval process and clinical training requirements. Student to instructor ratio not to exceed fifteen to one (15:1) and the Instructor must have no other duties while providing immediate and direct supervision of students. P&P must address procedure to ensure compliance.
- Attendance - Student absenteeism and makeup policy must be clearly stated. Makeup is "hour for hour", and covers same Modules, components and content as originally missed. Makeup instruction must follow the approved curriculum and lesson plans. Instructor must be present and available for questions during all training; including makeup.
- Program Monitoring – Each training program must be monitored for regulatory compliance and to verify that it is operating within the program requirements as per the policy and procedure manual. Monitoring criteria and specific details regarding the monitoring process should be included. A monitoring tool or checklist must be developed and included in the "Form" section, in the P&P.
- Recordkeeping and form retention – Policy must identify all program related documents to be retained by the training program. Details must include the timeframe for keeping records, the locked location where records will be stored and how recordkeeping is accomplished.