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 check list, 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
- Infection control
- 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 plus one additional hour from 8E, 8H, 15A, 15C or 16C. 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:
Nurse Assistant Training Program (NATP) Responsibilities:
- Prior to direct patient contact in the facility, the student must receive the federally mandated 16 hours of training regarding specific topics.
- Provide all clinical training and will provide immediate and direct supervision of students.
- Student to instructor ratio shall not exceed 15 students per Instructor.
- Provide facility with a list of names of all students along with the training schedule that will be followed.
- Provide all clinical training in the Department approved facility, by a Department approved instructor, while following the NATP schedule.
- Provide notice to the facility, that all students have had the physical examination, test for TB (not less than 90 days prior to patient contact) and criminal screening (upon enrollment to the NATP).
- Training will be provided between the hours of 6 a.m. and 8 p.m.
- Training will provide a minimum of 100 hours of clinical training in the facility.
- Facility staff may not be used to proctor, shadow, or teach the NATP students.
- Facility nursing staff will not be decreased because students are training in the facility.
Both parties agree to:
- Provision for adequate notice of termination.
- Both entities must agree to comply with all local, state and federal laws and regulations.
- Names and addresses of both parties, including signatures and dates.
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.
Per California Code of Regulations, Title 22, Section 71828, NATP providers must develop and implement written administrative and management policies governing the program. A copy of these written policies shall be submitted to the Department during the initial application review and any other time requested by the Department. The Department will review the policies to ensure compliance with Department regulations/requirements and to verify NATP staff has fundamental operational and regulatory knowledge.
The P&P Manual must be presented in a complete, consolidated, and organized fashion. All pages must be numbered, and each policy should be contained on separate pages. The NATP name should be on each page and pages should be formatted following the provided example. The P&P must include a “Table of Contents Page” and a separate “Forms Section” to include all forms used by the NATP. The Department must be able to clearly identify all elements of each policy and verify adequate content. Failure to submit a detailed, comprehensive, organized P&P Manual will result in the non-approval of an initial application and can result in the termination of an existing approved NATP.
Each policy must include and clearly specify:
- A policy statement that indicates the rule, regulation or requirement the program expects the employees to follow.
- A purpose statement to explain the reason for the rule stated in the policy statement.
- An applicability and scope statement to explain which employees are affected by the policy.
- A responsibilities statement to indicating which employees are responsible for development, enforcement or implementation of the policy.
- Itemized procedural steps that identify who, what, when, where, & how details. The details provided should include adequate instruction for the responsible employee to follow and carry out their job functions and responsibilities as stated in the policy.
- An effective date, which indicates when the policy comes into force.
Submit portions of the student handbook pertaining to admission, criminal background clearance, physical exam, attendance and course completion. P&P manuals that do not include the basic items listed above will not be accepted for review.
Policies and Procedures must include one or more policies covering the following categories and addressing all items listed below:
- Development, implementation, changes, updates and annual review of the P&P Manual. Identify employee(s) responsible for each function and how the training program NATP will ensure staff has adequate knowledge of policies. Provide specific details in order for staff to carry out the policy. Indicate the timeframe for annual P&P review. Include audit form in forms section. (See CDPH Sample Policy and Procedure format)
- Staffing policy to include job descriptions and qualification for all staff. Policy must include information for Administrator, Instructor, RN Program Director and any other NATP staff. Job title listed in the NATP policies must match and be included in the organizational chart. Instructor and RN Program Director qualifications, the approval process and license requirements must be included. Each responsibility listed in other policies should be included in the job description for the appropriate individual. In smaller organizations, one individual may hold two or more job titles. Include qualifications and job description for each required job title even when one employee will fill two jobs.
- Development, changes and maintenance of the organizational chart. In addition to the policy, include an organizational chart that indicates all job titles and lines of authority. The Administrator, RN Program Director, Instructors, and any other positions or job titles providing support to the NATP should be included.
Advertising requirements including advertising rules, advertising development and approval processes. The advertising policy must ensure that the NATP will not make any false or misleading claims or advertisements. The NATP may not advertise or guarantee certification to students. Include the compliance monitoring process for advertising and the monitoring requirements and process.
a. Initial application process to include the submission of the CDPH 283 CNA/HHA application form, Live Scan BCIA 8016 form and CDPH 283I form to the Department’s Aide & Technician Certification Section Registry upon student enrollment.
b. Criminal background clearance requirement and process. All students must complete Live Scan fingerprinting upon enrollment and prior to beginning clinical training or direct contact with patients. Detail the process for completion and submission of initial CDPH 283B. Students fill out Sections I-III and NATP process to completion of section IV. Indicate details of the submission procedure. Passage of SB1384 (Chapter 847, Statutes of 2014), contains important information regarding the criminal background requirements. Applicants are encouraged to read this senate bill and incorporate these requirements under this policy topic. The “Disqualifying Penal Code Sections” list no longer applies to CNA’s and NATP applicants.
c. Health requirements and processes to include gathering medical history and physical examination within 90 days prior to student participation in segments of the program involving direct contact with patients. Include the details for determination that the individual is free of active tuberculosis disease as per tuberculin infection testing method(s) recommended by the Federal Centers for Disease Control and Prevention (CDC) and licensed by the federal Food and Drug Administration (FDA). Expand upon requirements for when that test is positive; how an x-ray of the lungs must be performed and a certificate from the examining practitioner indicating the individual is free from active tuberculosis must be obtained. Include information regarding the report that must be signed by the physician, physician’s assistant or nurse practitioner and that the report shall be provided to the nursing facility. This report shall also indicate, “the student does not have any health condition that would create a hazard to himself, fellow employees, or patients.”
a. NATP schedule Development and implementation. Completed schedule must include all required hours, modules, components and skills per Title 22, §71835(n) as well as the document revision date. Schedule must also include designated makeup times to cover allowable absences per attendance policy. Procedure must include sufficient detail to guide the responsible employee in the development, implementation and Department approval process. P&P must demonstrate that applicant understands the Federal requirements that must be met prior to clinical skills training and required hours and components for course completion. All training schedules must be approved by the Department prior to implementation. The school may include lab practice in the curriculum. Lab practice cannot be counted towards the theory or clinical training hours.
b. Classroom theory training may only be provided at the theory classroom location approved for use with a specific NATP identification number. All training must follow the curriculum, lesson plans and NATP schedule that have been approved by the Department for use with this specific NATP. Federally required 16 hours of theory training must be completed prior to direct patient care in the clinical class. The policy must indicate who will be responsible for verifying that each student has completed the training prior to start of clinical training.
Standardized forms must be used to document all theory training. The policy must establish whether the NATP will use the CDPH 276C (Individual Student Record) or if the NATP has developed an alternate form for this purpose. If an alternate form is used, the policy must instruct employees on the form requirements regarding development, required Department approval prior to use, proper use procedures and implementation. This document must contain all information as shown on the current CDPH 276C. All documentation of student progress must be hand-written.
The policy must establish which curriculum the NATP will be following. If the NATP chooses to use a curriculum other than a Model Curriculum listed on the Department website, the P&P must include information regarding the process and responsibilities for the development, implementation and evaluation of this curriculum. Identify if lesson plans are from a model curriculum or will be developed by the NATP. If the policy states that the NATP will develop the curriculum (including lesson plans), the procedures must clearly detail the process and steps for developing the curriculum and lesson plans. Student attendance (sign-in/sign out) sheets must be developed, implemented and maintained for all training, and include date, printed/typed name of student, student’s signature (beginning and end of each training day), and name and signature of instructor.
c. Clinical facility training must be completed at the Department approved clinical training facility between the hours of 6 a.m. and 8 p.m. Each clinical Instructor may not have any other duties while providing immediate and direct supervision to no more than 15 students. Policies and procedures must detail rules and processes surrounding clinical site approval, compliance methods to ensure adherence to training schedule and all hours and skills are met per Title 22, §71835. All clinical modules and lesson plans are available for Instructor use and Department review upon request. Identify NATP personnel responsible to implement chosen curriculum and lesson plans. If the NATP policy is to establish a customized curriculum, the policy must include all details for curriculum development. Describe how the Clinical Instructor must provide a demonstration of clinical skills at the nursing facility (Department approved clinical site) and perform student return evaluations for all skills on CDPH 276A or Department approved Student Skills Checklist at the nursing facility. NATP cannot waive any skill on the CDPH 276A form pursuant to Title 22, §71835. All skills are to be successfully demonstrated by the student, on a facility resident, with the Department approved Instructor present. Simulation process and exception requirements can be utilized, if a skill cannot be demonstrated on a resident in the facility and P&P allows for and details the simulation process. All skills must be evaluated by a Department approved Clinical Instructor with hand written documentation, on the date the skill was performed. Sign-in/sign out sheets are required for every day of clinical training. The sheet should include the date and time of clinical, printed/typed name and signature of instructor, printed/typed name of student, and signature of student. Student attendance sheets will be used by the RN Program Director to verify each student completed 100 hours of clinical training.
d. Course completion and verification processes must be established. RN Program Director must verify all hours, modules and components being successfully completed by each student prior to signing CDPH 283B. This is usually done through a review of review the CDPH 276A, CDPH 276C, student attendance and sign-in sheets (including make-up sessions). The signing of the CDPH 283B may occur only after the student meets state and federal NATP requirements and is eligible to take the CNA competency exam.
Attendance and makeup policies must be established. Rule for number of absences per student must be established. Procedures for makeup must include acceptable makeup which is to be “hour for hour”, for same Modules, components and content as missed and must follow the approved curriculum and lesson plans. The Instructor must be present and available for questions during all training, including makeup. Attendance records to document both classroom and clinical training hours must be kept. Sign in/sign out (Attendance records) shall include the date and time of instruction, the name and signature of the student, and the name and signature of the instructor.
Program Monitoring criteria, processes and timeframes must be established and include specific details of how the monitoring will be completed. The monitor should verify that the approved NATP schedule and the approved lesson plans are being followed. The monitoring should verify documentation is complete, initiated by the proper individual, handwritten and does not contain blanket signatures. Is each student completing all required hours, modules, components, skills prior to the 283B forms being submitted to the RN PD for signature? Monitoring policy must include the frequency of monitoring which should occur at least once for clinical and once for theory for each class. The monitoring should be listed in the job description of the RN PD who monitors the NATP operation and the Administrator who monitors the RN PD to verify compliance monitoring is taking place per the policy. Evaluation tools used for monitoring should be included in the “Forms” section of the policy and procedure manual.
RN Program Director (RNPD) Oversight of Multiple NATP Locations or Outside Employment policy must be established. Will the NATP allow the RN program Director to oversee multiple training programs or training locations? If so, this must be included in the RN PD job description. Define the maximum number of NATP program and locations the RN PD may oversee. Will the NATP allow the RN PD to have outside employment? Any policy that allows for RN PD oversight of multiple programs, locations or outside employment requires Department review and approval. The RN PD must submit a letter to the Department listing employers, job titles, hours of employment and employment locations along with a statement describing how all job duties will be met. How will NATP verify that RN PD is meeting all NATP responsibilities as outlined?
Recordkeeping and form retention policy must list and provide detailed information regarding all forms and documents to be used, maintained and retained by the NATP for a minimum of four years. Who will be responsible for form development, implementation, completion and storage? Copies for all of the forms listed in this policy should be included in the “Forms” section of the policy and procedure manual. Any form listed in the P&P manual or student handbook, related to NATP evaluation, health exam, and absenteeism or student attendance must be provided as part of the P&P review. All forms must be current and include a revision date. Address how security is maintained for documents that are removed from the designated storage locations, such as student CDPH 276A and CDPH 276C forms during training. Address timeframe for keeping records, they are to remain in a locked location and specify the locked location and those with access. All student records must be completed and verified by the RN Program Director prior to signing the CDPH 283B.
Competency Evaluation Testing may only be performed by CDPH approved testing vendors. Students may only be referred to and test with the American Red Cross or the National Nurse Aide Assessment Program. The NATP policy must include the process for scheduling of testing. Procedural steps for the content, sources and methods of proving competency evaluation testing information to students must be included.
Additional Training Program Requirements
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.
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.