§ 71847. In-Service Training Program.

(a) Each facility shall complete a performance review of every nurse assistant employed by the facility at least once every 12 months and must provide regular in-service training based on the outcome of these reviews.

(b) In-service training programs shall take place in a nursing facility. Such facility shall have a written plan describing its in-service training program.

(c) Applications for approval and renewal of written plans for in-service training programs shall be submitted to the Department for approval at the address specified in Section 71833(b).

(1) Starting from the date the Department receives an application for an in-service training program, the applicant shall be informed within 30 days whether the application is complete and accepted for filing or that the application is deficient and what specific information is needed.

(2) An application shall be considered complete when received by the Department with all the requirements in subsections (d), (e) and (f) of this section included.

(3) Starting from the date a completed application is received, the Department will make a decision whether to approve or disapprove it within 90 days. The Department's time frames for acting on an application for approval of an in-service training program are as follows:

(A)	Minimum	30 days.
(B)	Median	60 days.
(C)	Maximum	90 days.

(d) Each application for approval or renewal of an in-service training program shall include:

(1) A three (3) month in-service schedule.

(2) A course title, course outline, core curriculum and lesson plan(s). The lesson plan must include student performance standards and a description of topics included which provides the Department with adequate detail (i.e., method, technique, procedure) to discern what is taught. The lesson plan must describe the method of teaching and the method of evaluating the results of the training.

(3) The number of hours for presentation and presentation dates.

(4) The method to evaluate learning when audio/video tapes or films are used.

(e) Each nursing facility shall include a schedule to demonstrate how it will make available twenty-four (24) hours of varied in-service training annually. The in-service training shall include multiple subjects.

(1) In-service training program sessions shall be made available to all employed certified nurse assistants who shall receive at least the normal hourly wage for attending the program.

(f) The content of the in-service training program shall enhance knowledge and skills learned in the certification training program and shall also address areas of weakness as determined by a nurse assistant's performance reviews, areas of special needs of the patients, including those with cognitive needs, and areas wherein the facility received deficiencies related to patient care following the last licensing survey. Subjects may include, but are not limited to:

(1) Working with patients who have special problems such as blindness, deafness, confusion or communication disabilities.

(2) Bladder and bowel training and management.

(3) Signs, symptoms and probable causes of patient distress with procedures to be followed for alleviating distress and emergency procedures for the relief of choking.

(4) Psychosocial aspects of aging and/or chronic illness as relevant to the individual, family and community.

(5) Patient care elements including planning and organizing work while individualizing patient care; testing urine for sugar and acetone; measuring blood pressure and administering nonmedicated enemas.

(6) Nursing care relevant to body systems including, but not limited to, fractures, diabetes, cardiac disorders, dementia, cerebrovascular accidents, arthritis, pulmonary disorders and infectious diseases including Acquired Immune Deficiency Syndrome (AIDS).

(7) Nutritional needs of patients and related nursing interventions.

(8) Oral hygiene.

(9) Patient care conferences and patient care plans involving the patient and the patient's family.

(10) Improving skills in observation, reporting and recording of patient information.

(11) Developing effective relationships and means of intervention on behalf of the patients.

(12) Social and recreational needs of the patient.

(13) Working with the dying patient and the family.

(14) Environmental safety including fire and accident prevention.

(15) Universal precautions for infection control including methods to handle all patients and all materials that are soiled with blood and/or body fluids from all patients. The methods prescribed shall be developed to reduce the risk of transmission of potentially infectious etiologic agents from patients and between patients and health care workers.

(16) Patients' rights and civil rights.

(17) Disaster preparedness.

(18) Sensory deprivation and stimulation.

(19) Maintenance of healthy skin: prevention of skin breakdown, body positioning and range of motion.

(20) Use of adaptive equipment relevant to nutrition and physical dysfunction.

(21) Safeguarding patients' personal property through compliance with the facility's theft and loss prevention program.

(g) In-service training programs shall describe what staff needs were assessed, how the program plan will meet those needs, how the plan will be implemented and how staff learning will be assessed.

(h) Each nursing facility shall submit a renewal request for the Department's review and approval every two years and not later than thirty (30) days prior to a change in core curriculum content or training hours or thirty (30) days following a change in program staff.

(i) A nursing facility shall keep all records of in-service training programs on file for a period of four years starting from the date the first classes were offered.

HISTORY

1. New section filed 7-16-91 as an emergency; operative 7-16-91 (Register 91, No. 46). A Certificate of Compliance must be transmitted to OAL by 11- 13-91 or emergency language will be repealed by operation of law on the following day.

2. New section refiled 11-14-91 as an emergency; operative 11-13-91 (Register 92, No. 8). A Certificate of Compliance must be transmitted to OAL 3-12-92 or emergency language will be repealed by operation of law on the following day.

3. Editorial correction of History 2. filed and new section refiled 5-6-92 as an emergency; operative 5-6-92 (Register 92, No. 20). A Certificate of Compliance must be transmitted to OAL 9-3-92 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 5-6-92 order including amendment transmitted to OAL 8-27-92 and filed 10-9-92 (Register 92, No. 41).

Note

Note: Authority cited: Sections 208(a), 1275 and 1338.3, Health and Safety Code. Reference: Sections 1337.1(c), 1337.1(d), 1337.3, 1337.5(a) and 1337.6(a), Health and Safety Code.