The following items must be submitted for renewal of SNF and ICF related programs. Please follow the instructions listed in the Combined Renewal Application for SNF/ICF (CDPH 278R).
If your facility conducts its own Nurse Assistant Training Program (NATP), submit the following for renewal with the CDPH 278R:
Nurse Assistant Certification Training Program Application (CDPH 276S or 276F)
California Code of Regulations (CCR) Title 22, Section 71835(n) specifies the mandatory theory and suggested clinical hours for each module. The Nurse Assistant Certification Training Program Application for Schools (CDPH 276S) and the Nurse Assistant Certification Training Program Application for Skilled Nursing Facilities (CDPH 276F) are two sided forms. Enter the theory and clinical hours in your training schedule on page two, which requires the total number of hours for each of the sixteen modules. California requires 160 hours of training to complete the program. The minimum number classroom theory training is 60 hours and 100 hours of supervised clinical training is required. Include all supporting documentation listed on the back of the form.
The provider identification training number will be assigned once the program is approved. Each provider identification number is approved for use only at the approved location using the approved training schedule. Each classroom training location or training schedule will constitute a distinct training program. A new application, Department approval, and provider ID is required for each additional training schedule and/or classroom location.
Applicants may not submit multiple applications at one time. Providers Identification Numbers are non-transferable.
Lesson plans covering 4 of the 16 modules must be submitted. Include Module 8, "Patient Care Skills" plus any three of the remaining modules. Each lesson plan must include all topics for the entire Module and shall include learning objectives, content outline, method of teaching and method of evaluation.
The NATP is required to provide 100 hours of clinical training under the immediate supervision of the Instructor. The training shall include demonstration of basic patient care skills by the Instructor. The demonstration is to be based upon the theory and clinical instruction presented in the classroom. Return demonstrations by the student are also required and shall be under the immediate supervision (present when student is performing the skill) of the Instructor and shall be done in the clinical setting with residents (patients).
The Nurse Assistant Training Program Skills Check List (CDPH 276A) is a sample which may be copied and used for each student in the NATP. Use of this form will ensure the program meets the requirements for documentation of clinical skills training. Applicants may develop a skills checklist, however it must include the minimum skills listed on the Department's Nurse Assistant Training Program Skills Check List (CDPH 276A). This Skills Check List shall include a listing of the duties and skills the nurse assistant must learn, space to record the date when the nurse assistant performs this duty or skill, space to note satisfactory or unsatisfactory performance, and space to record the initials and title of the Department approved instructor who witnessed the return skill demonstration.
This record serves as the primary documentation for the clinical hours and skills that must be implemented in the NATP, and is the fundamental resource that the RN Program Director uses to ensure that the 100 hours and skill performance has been met for each individual student. Approved NATPs must keep accurate, complete and ethical documentation.
A note of importance: After the completion of the NATP training, the RN Program Director must attest on the Initial Application (CDPH 283 B) with the completion signature, that the student has met all the clinical and classroom training requirements.
A day to day schedule must be submitted. This schedule must list all training including 60 hours of classroom theory and 100 hours of clinical training. All required Modules, components, and skills are to be included. Please give considerable attention to the required training program schedule, as it must be detailed enough for the TPRU representative to determine what is being taught on what day and time. A complete training program schedule, will address all the topics and subtopics on the Nurse Assistant Certification Training Program Individual Student Record (CDPH 276C) and all the skills on the Nurse Assistant Training Program Skills Check List (CDPH 276A). Theory topics must be taught prior to skills training for that topic. For example, theory for infection control and hand washing must be taught prior to clinical skills training on that topic.
Lab hours, aka "Skills Lab" may be included the curriculum, but cannot be counted towards the classroom or clinical hour requirements. Any additional hours of training must be included on the training program schedule. It is recommended that lab hours be added to the curriculum to allow for skill demonstration practice prior to the clinical training.
Make-up time must be included in the training schedule, and any missed theory training must be made up by the student prior to clinical instruction. Make-up time is made up hour for hour, and must be overseen by the instructor. The make-up must cover the same content that was missed, following the Module lesson plan. The NATP must create a policy that limits the amount of absence and makeup that will be allowed.
Once the training schedule is approved by the Department, this is the only schedule that the NATP can use. If the NATP desires to change the schedule (sequence of modules or provide the training at a different time (weekend vs. days), then the Training Program must submit the new training schedule to the Department for approval prior to implementing the change in the schedule. Once reviewed and approved, the updated schedule will be replaced with the previously approved schedule.
During any onsite visits, the Department will make a determination if the school is implementing the approved training schedule. There is only one approved training schedule for each provider identification number assigned to each NATP.
A Sample Daily Nurse Assistant Training Program Schedule (CDPH 276B Sample) which shows the formatting for training schedule development has been provided. This sample provides detail for classroom and clinical training over several days. The schedule submitted by the NATP applicant must cover the entire NATP. Please note that lunch and break times are not included in training time and should be subtracted from total program hours.
The NATP schedule must contain all the required content areas listed in CCR, Title 22, Division 5, Chapter 2.5, Section 71835(n). There are 16 hours of state and federal required training in the following areas prior to any direct contact with a resident:
Communication and interpersonal skills
Safety and emergency procedures including the Heimlich maneuver
Promoting the independence of patients/residents
Respecting the rights of patients/residents
This requirement is met if all theory components of the following modules are taught prior to clinical training; Modules 1,2,3,4,5,6,12,14. The students may then begin the clinical portion of the NATP. The remainder of the classroom theory modules must be taught in conjunction with the clinical training. A NATP may choose to teach all 60 hours of theory at the beginning of the program. This can be done if significant laboratory skills' training is provided in conjunction with the theory training. Clinical training for 100 hours may then follow. Laboratory time does not count as part of the required 160 training hours.
The Nurse Assistant Certification Training Program Individual Student Record (CDPH 276C) is the Department form for documenting the student's theory classroom training (minimum 60 hours). The form may be copied and used for each student in the NATP. Use of this form ensures compliance in documentation for all hours, modules and components of classroom theory training.
The Nurse Assistant Certification Training Program Individual Student Record (CDPH 276C) serves as the primary documentation for the theory/classroom hours that must be implemented in the NATP, and is the fundamental resource that the RN Program Director uses to ensure that the 60 hours and classroom theory training Modules and components have been met for each student. Approved NATPs must keep accurate, complete and ethical documentation.
Each instructor must be approved by the Department prior to providing training for each NATP. The Program Director must be a Registered Nurse and is an approved instructor for this NATP. Instructor approval may be prior to or concurrent with the Program Director designation.
NATP Instructor Requirements
Valid nursing license (RN or LVN).
2 years of nursing experience [RN, LVN].
1 year verifiable experience as a licensed nurse providing care and services to chronically ill or elderly patients in in an acute care hospital, skilled nursing facility, intermediate care facility, home care, hospice care, or other long-term care setting.
Must have ONE of the following:
[Verifiable] completion of a course in teaching adults; OR
Completion of a 24-hour course in "Planning, Implementing and Evaluating Educational Programs in Nursing" satisfies this requirement.
Completion of a course approved by the Board of Registered Nursing (BRN) or by an accredited educational institution satisfies this requirement.
A BRN continuing education course certificate used to meet this requirement must comply with the requirements found in 16 CCR, §§1450 et seq.
[Verifiable] experience in teaching adults; OR
[Verifiable experience] supervising nurse aides.
Nursing Facilities are required to employ a Director of STAFF development (DSD). The DSD is often the Instructor for SNF owned and operated NATPs.
Agencies and Public Institutions do not typically employ a DSD, so the NATP is taught by an Instructor or Program Director, RN.
The Program Director, RN Requirements
Must have a valid RN license.
Must be a Department-approved NATP Instructor or facility DON in a facility-based program who meets the requirements found in 42 CFR 483.152(a)(5). The facility DON is prohibited from performing the actual training [theory and clinical].
The Program Director RN is responsible for the general supervision of the NATP in a non-SNF owned NATP. The general supervision should include, but is not limited to oversight of instructors, curriculum, verification of student training, and signing of CDPH 283B after the student successfully completes the NATP (attesting that all state and federal training requirements are met).
In order to be approved as the Program Director for the NATP, the RN must be approved as an Instructor for the NATP. See DSD/Instructor requirements above. Additionally, the NATP must submit the CDPH 276 form which designates the Program Director. The CDPH 276S or CDPH 276F must be submitted in order to designate an approved Instructor as the RN Program Director for the NATP.
The NATP must provide 100 hours of clinical training in a Department approved long-term care facility. There must be a written agreement between the NATP and the long-term care clinical facility where the training is provided. The agreement must be approved by the Department prior to clinical training taking place. This form is not required for programs conducted directly by nursing facilities.
The NATP applicant must have a written agreement with the long-term care clinical facility where they will provide the required 100 hours of clinical training for students. The required clinical training must be provided in the approved SNF between 6:00 a.m. and 8:00 p.m.
The facility must be in good standing with the Centers for Medicare and Medicaid Services (CMS) and not have any training enforcement restrictions. If the facility has a two-year Nurse Assistant Training Program ban, the clinical site agreement will be void and the NATP will not be allowed to conduct training in the facility. Programs should consider having more than one clinical site training agreement; in the event a facility comes under sanctions by CMS. This agreement must be developed jointly with the clinical facility and signed by both parties. The agreement period shall correspond with the NATP approval expiration date will be for a maximum of two years. The Department CDPH 276E form may be submitted for approval or the clinical site contract between the parties may be submitted, but the agreement shall state the responsibility of the NATP to the facility and the facility to the NATP and shall include the information listed on CDPH 276E.
Clinical Site Contracts
A Skilled Nursing Facility (SNF) that hires nurse assistants, but does not provide in- house NATP training, must contract with a Department approved NATP to provide the required training to its nurse assistant employees. The contract must have adequate provisions to describe the responsibilities of the Department approved NATP to the SNF, and must be approved by the Department. The elements of a contract are similar to the components of the clinical site agreement noted above, except that the NATP will provide all classroom and clinical training. The contract must describe the address/location where the classroom training will occur. If the classroom training will occur at the SNF location, then the contract must also specify the area of the facility which will be used for the instruction. A copy of the lease/rental agreement for the facility space must be submitted. The area must not be licensed as resident space and must have a separate entrance and egress for students. This area must not infringe on resident privacy. The Department will determine if the space can be approved for classroom student use.
The NATP shall not use facility personnel as preceptors or instructors. NATP instructors must not be employees of the facility while teaching. The SNF DSD may teach an evening or weekend class for the NATP school if not employed during those hours with the SNF. The Director of Nursing (DON) in the SNF may not be a NATP instructor, since the DON of a facility is employed full-time and has a twenty-four (24) hour responsibility to the SNF.
Administrative Policies and Procedures Manual
Per California Code of Regulations, Title 22 (22 CCR), §71828, Nurse Assistant Training Program providers must develop and implement written administrative and management policies governing the program. The Department has developed a template (CDPH 276P form) (PDF), for Nurse Assistant Training Program providers, which includes the policies and procedures that are minimally required per regulation. Each Nurse Assistant Training Program applicant must complete the template and sign the attestations as part of their application package.
Nurse Assistant Training Program applicants must also develop and submit an organizational chart, job descriptions for training program staff and a checklist for the required Instructor monitoring, as per 22 CCR, §71828. The instructor monitoring checklist should provide for verification that the program is conducted in accordance with the approved plan. Examples of items to be included in the instructor monitoring checklist are; "teaches according to the approved training schedule", "provides the required clinical training at the approved clinical training site", etc. In accordance with best practices, applicants will want to develop additional policies and procedures as needed, to cover student enrollment, criminal background clearances, student health examinations, student testing, etc.
Additional Training Program Requirements
Certified Nurse Assistant Application and Live Scan
Upon enrollment in a NATP for nurse assistant certification, a candidate for training shall submit a training and examination application along with the proof of Live Scan fingerprinting to the Department. The application and Live Scan must be submitted prior to any direct patient contact with residents.
Physical Health Examination
Each student enrolled in the certification program shall have a health examination which includes a medical history and physical examination, a purified protein derivative, intermediate strength intradermal skin test for tuberculosis, unless medically contraindicated. If a positive reaction is obtained, a chest x-ray shall be taken, unless medically contraindicated. A report signed by the examiner shall indicate that the student does not have any health condition that would create a hazard to themselves, fellow employees, or patients. This examination shall be completed and documented prior to the student having direct patient care contact in the clinical setting. This information shall be provided to the nursing facility prior to patient contact. The physical health examination must be done within 90 days prior to clinical training/direct patient contact.