The following items must be submitted for application consideration:

• 40 hour Home Health Aide Training Program (CDPH 171) (PDF) (Revised 02/19)
• Curriculum Acknowledgement for 40 hour Home Health Aide Training Program Application (CDPH 171A) (PDF) (Revised 02/19)
• Instructor Approval (CDPH 171B) (PDF) (Revised 04/14)
• Must be included even at renewals
• Important Update: There must be a valid resume on file with the Department for all Department approved training program Instructors.
  
• Disclosure of Ownership (CDPH 276D) (PDF) (Revised 04/14) - For proprietary providers/schools only
• Clinical Site Agreement(s) (CDPH 276E) (PDF) (Revised 04/19)
  
• Administrative Policies and Procedures as they apply to the 40 hour Home Health Aide Program.
• Sample Student Record (A form to document and validate the classroom theory and clinical skills)
• One Sample lesson plan
• Copy of the Business License - For proprietary providers/schools only
• Contact Information Form (CDPH 193) (PDF) (Revised 12/19)

Information regarding the 40 hour Home Health Aide Training Program (HHP):

Only individuals with a current Certified Nurse Assistant (CNA) certificate may enroll in a 40 Hour HHA Training Program (HHP) to become a certified Home Health Aide (HHA). The Department may allow individuals who have successfully completed the 160 hour Nurse Assistant Training Program (NATP) to enroll in a 40 Hour HHA Program if the school/provider has a "separate and consecutive" program.

Such NATP programs may end the NATP training one day and begin the HHP the next day. If a training provider is running a separate and consecutive training program, then they must do the following:

• Ensure the NATP and HHP are offered as separate programs.
• The NATP program must follow the NATP curriculum and approved schedule, (including clinical hours).  Training to be provided by NATP approved instructor at approved classroom and clinical locations. 
• Begin HHP training only after successful completion of the NATP training.  The separate HHA training must follow the HHP curriculum including clinical hours.  Only Department approved HHP Instructors will provide HHA training at approved classroom and clinical locations.
• Each NATP and HHP has its own start and end date and is advertised as two separate classes.
• Submit a separate Initial Application (CDPH 283D) be sent to ATCS for each separate program.
• Upon enrollment in the NATP course, notify future HHP students that an HHA certificate will not be issued by the state until they have passed the CNA Competency Examination given by a state approved testing vendor.

Application Submission Requirements

40 hour Home Health Aide Training Program (CDPH 171) (PDF)

Each applicant must submit a CDPH 171 Application for the 40 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.

Curriculum Acknowledgement of 40 hour Home Health Aide Training Program Application (CDPH 171A) (PDF)

Twenty (20) hours of HHA curriculum are in the classroom and twenty (20) hours are clinical, which are performed and monitored by the HHA RN Program Director in a clinical setting (Home Health Agency, Skilled Nursing Facility or Acute Care Hospital). The applicant, who is approved to implement a 40 Hour HHA Training Program, will abide by the regulations at CCR, Title 22, Section 74747(e), instructor requirements at Section 74747(d) and CFR, at Section 483.36; as well as maintain accurate students' records for a period of four (4) years.

Sample Student Record

Submit a copy of the forms that will be used to document and validate the classroom and clinical curriculum; including 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.

Instructor Approval (CDPH 171B) (PDF)

Each instructor must be approved by the Department prior to teaching. 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 171B 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/phone number of employer and the name of the supervisor. Resumes that lack verifiable information will not be approved.

Clinical Site Agreement(s) (CDPH 276E) (PDF)

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:

1. Separate responsibilities for the Training Program and the health facility. 
2. Include the name and address of the parties, and be signed by the facility administrator and training program Owner or Administrator.
3. The agreement must be a closed-ended contract with a specific expiration date.  The agreement is valid for a maximum two-year period.
4. Both parties must agree to follow all local, state and federal laws and regulations.
5. 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 the facility during the clinical training.
6. The skills must be evaluated in the clinical setting with patients and recorded on the student record.
7. The school must work collaboratively with the facility to establish a clinical schedule that includes specific training dates and times.
8. The school will furnish the facility with a list of student names including dates and times of the training schedule.
9. 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.

The Training Program must supply a list of student names to the facilities that have met the above criteria. 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.