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Licensing and Certification

In-service and Orientation Applicants

In-service and Orientation programs are required for all Skilled Nursing Facilities (SNF) and Intermediate Care Facilities (ICF).  

The following items must be submitted for application consideration:

  • Nurse Assistant Orientation Program Content (CDPH 278A) (PDF) (Revised 12/19)

    • Submit a lesson plan for a direct patient care skill that is taught during supervised clinical training included in the first 8 hours of the orientation.

    • Submit a copy of the orientation skills return demonstration record used to document the basic patient care clinical training from first 8 hours of the orientation.

  • In-Service Training Program (CDPH 278B) (PDF) (Revised 12/19)

    • Submit two lesson plans. The lesson must be for two different courses that you listed on your CDPH 278B form.

    • Submit a three-month in-service schedule for future months.

    • Submit a copy of the in-service sign-in sheet. It must include the following:

      • Name of the health facility

      • In-service course title

      • Date of in-service

      • In-service start time and end time

      • Instructor name (typed/printed) and instructor's signature

      • Participant's name (typed/printed) and participant's signature 

      • Participant's CNA or HHA certification number            

    • Submit a copy of the record keeping policy. It must include the following:

      • Which in-service records are maintained (sign-in sheets, lesson plans, written exam etc.)?

      • How long (4-year minimum) are the In-service records maintained?

      • Storage location address.

      • How records are stored (hard copy or digital)?

      • The title of the person responsible for the record keeping.                                    

  • Facility Declaration of Participation in Approved Training Programs (CDPH 278C) (PDF) (Revised 01/20) - Required for Skilled Nursing Facilities (SNF) and Intermediate Care Facilities (ICF) only

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