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State of California—Health and Human Services Agency
California Department of Public Health

TPRU/ELRU E-Blast 22-02
June 10, 2022

Skilled Nursing Facilities (SNF)
Intermediate Care Facilities (ICF)
ICF/Developmentally Disabled (ICF/DD)
ICF/DD Nursing (ICF/DDN)

New Streamlined Renewal Process for Facility-Based Nurse Assistant Training Program, Orientation, and In-service Training Programs

Authority:       Code of Federal Regulations (42 CFR) section 483.151(d) and (e),

                              California Code of Regulations, Title 22 (22 CCR) sections 71829(a), 71833, 71835, and 71847


The California Department of Public Health's Training Program Review Unit (TPRU) and E-Learning Review Unit (ELRU) oversee classroom and online training for healthcare providers.

The Department has created a new renewal form entitled Certified Nurse Assistant Orientation, In-service, and Nurse Assistant Training Program Combined Renewal Application (CDPH 278R).  This new renewal form combines the renewal processes for facility-based Orientation, In-service, and Nurse Assistant Training Programs (NATP).

The CDPH 278R form and an instructional presentation are located on the TPRU website.  Effective the date of this notification, all SNF, ICF, ICF/DD, and ICF/DDN (facilities) must email their completed CDPH 278R form to TPRU at or fax it to (916) 636-6760.  The Department encourages facilities to submit their application up to 90 calendar days prior to their expiration date to renew their facility-based NATP and/or Orientation and In-service agreement with TPRU.

The initial NATP application process is unchanged.  Please visit the NATP webpage for all items needed for consideration of an initial NATP application.

The online NATP renewal process for ELRU is unchanged and is available on the Unit's website.


All facilities must renew their In-service Training Program and facility-based NATP at least every two years. Orientation Training Programs must only submit changes to their programs when they occur.

New Streamlined Renewal Form

The Department recently streamlined its renewal processes for classroom facility-based Nurse Assistant, Orientation, and In-service training programs and created the form entitled Certified Nurse Assistant Orientation, In-Service, and Nurse Assistant Training Program Combined Renewal Application (CDPH 278R).  This new form, located on the TPRU website, requires facilities to provide an attestation and specific information and forms about their facility-based training programs.

Initial NATP Application Process Unchanged

Please note, that your facility may apply for a facility-based NATP at any time.  Please visit the NATP webpage for all items needed for consideration of an initial NATP application.

Instructor or Director of Staff Development (DSD) Requirements Updated

The Department must approve instructors and DSDs with each new employment. The application must be accompanied by a resume and supporting documentation such as continuing education certificates in planning, implementing, and evaluating educational programs in nursing.  The minimum qualifications for the Instructor and DSD are detailed on the form entitled Instructor or Director of Staff Development (DSD) Application (CDPH 279) (PDF).

The following are instructions regarding the completion of the CDPH 278R (PDF):

Section A:  Orientation Training Program

The Certified Nurse Assistant (CNA) Orientation Training Program only needs to be updated if changes have been made since your last renewal.

Section B:  CNA In-service Training Program

Facilities must submit a three-month In-service schedule for future months, one in-service lesson plan from the Course Titles listed on your three-month in-service schedule, and either declare that the facility uses the template form CDPH 278D (PDF) In-service Training Attendance Sign-in Sheet for your in-service program or provide your own sign-in sheet that meets the requirements.

Section C:  Declaration of Participation in Approved Training Programs

Your facility must select the option that applies to your facility.

  • Option 1 is for a licensed facility that is currently or would like to directly conduct NATP training for their Nurse Assistant employees.  To renew your facility-based NATP, see Section D of the form CDPH 278R. If your facility would like to be a new NATP, it may apply using an initial NATP application.
  • Option 2 is for a licensed facility that provides the NATP for their Nurse Assistant employees through a written agreement (contract) with a department-approved NATP.  Please submit form CDPH 278SC Sample Contract (PDF). If the facility chooses this option, skip Section D of the CDPH 278R.
  • Option 3 is for a licensed facility that only hires CNAs with a valid certification. If the facility chooses this option, skip Section D of the CDPH 278R.

Section D:  Renewal of NATP

If the facility selects Option 1 in Section C, they must submit form CDPH 276F (PDF), form CDPH 278B (PDF), and any changes to the program since your last renewal (e.g., organizational chart, job descriptions, instructor monitoring tool, four lesson plans if your curriculum changed, CDPH 276P (PDF) policies and procedures, and CDPH 279 (PDF) for all new Instructors and DSDs).

Section E:  Compliance Statements and Attestations

The Facility Administrator, Director of Nursing, and DSD must sign and date that they reviewed the nine compliance statements, provided correct and accurate information, and will abide by all applicable codes, regulations, and rules pertaining to your facility's training programs.

Instructional PowerPoint Available

A new instructional PowerPoint presentation is available on the TPRU website to help facilities successfully complete the CDPH 278R form.  The Department encourages them to review the instructional presentation before completing the CDPH 278R form to facilitate submitting a complete and accurate renewal application.

New Renewal Form Required to Renew

Effective the date of this notification, all facilities must renew their Orientation and In-service agreements using the combined CDPH 278R form.  Facilities that also have a facility-based NATP, must renew their NATP, Orientation, and In-service agreements together using the CDPH 278R form.  Facilities that fail to submit the new form to renew their agreements after the date of this notification will be required to resubmit their renewal application using the new CDPH 278R form.

Submit New Renewal Form Up to 90 Days Prior to Expiration

The Department encourages facilities to submit their applications up to 90 calendar days prior to their Orientation, In-service, and facility-based NATP agreement expiration date.  Failure to submit the renewal application to TPRU prior to the expiration date may result in the cessation of your operation until an initial application can be approved.  If your program does not know the agreement expiration date, it can be found on all communication notices sent to the facility from TPRU.  The facility can also contact TPRU via email at

Facilities must submit applications to TPRU by email at or fax at (916) 636-6760. As of January 1, 2022, TPRU no longer accepts mailed paper applications.

Failure to Renew

Failure to renew the facility-based NATP will result in closure of the agreement due to expiration and removal of your training program from the statewide approved list.

Failure to renew the Orientation and In-service Training Program agreements may result in a referral to the Centers for Medicare and Medicaid Services, the supervising District Office, and the Nursing Home Administrator Program for noncompliance.

Update Your Contact Information

The Department encourages facilities to always update TPRU with the latest contact information by submitting a completed CDPH 193 form to TPRU at

Comply with All Requirements

It is the facility's responsibility to follow all applicable laws and regulations.  The Department encourages facilities to refer to the full text of all applicable sections of the Code of Federal Regulations, California Health and Safety Code, and California Code of Regulations, Title 22 to ensure compliance.

Renewal Process for Online Training Programs

The renewal process for online NATP training programs is unchanged and outlined on the ELRU website.

If you have any questions about this E-Blast, please contact the Training Program Review Unit via email at


Original signed by Terri Mack


Terri Mack, MPA, Chief

Healthcare Professional Certification and Training Section

Center for Health Care Quality

Department of Public Health

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