R432-45-5. Nurse Aide Training Requirements Under UNAR

  (1) UNAR shall administer a NATCEP through a contract with the Department of Health.

  (2) An agency that conducts a NATCEP must be UNAR-approved.

  (3) Applicants for approval of a NATCEP and all new NATCEP instructors must successfully complete a background clearance.

  (a) A NATCEP must submit required information to UNAR to initiate a background clearance for each applicant and instructor.

  (b) UNAR shall ensure:

  (i) required information is entered into the Direct Access Clearance System to initiate a clearance for each applicant and instructor;

  (ii) each applicant and instructor signs a criminal background screening authorization form which must be available for review by the department;

  (iii) each applicant and instructor submits fingerprints; and

  (iv) the Direct Access Clearance System reflects the current status of the applicant and instructor.

  (c) If the Department determines an applicant or instructor are not eligible, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to UNAR and the individual explaining the action and the individual's right of appeal as defined in R432-30.

  (4) In accordance with this section, UNAR shall review and render a determination of approval or disapproval of any NATCEP when a Medicare or Medicaid participating nursing facility requests the determination. UNAR at its option, may also agree to review and render approval or disapproval of any private NATCEP.

  (5) UNAR must, within 90 days of the date of an application, either advise the requestor of UNAR's determination, or must seek additional information from the requesting entity with respect to the program for which it is seeking approval.

  (6) UNAR shall approve a NATCEP that meets the criteria specified in OBRA, the Centers for Medicare and Medicaid Service's guidelines, guidelines designated by the Department of Health, and all UNAR requirements.

  (a) UNAR shall admit a student who is at least 16 years old on or before the first day the student begins class; and

  (b) shall include an orientation to the training program.

  (7) The nurse aide training program must meet certain content requirements to be UNAR-approved.

  (a) NATCEP must consist of at least 100 hours of supervised and documented training by a licensed nurse.

  (b) The curriculum of the training program must include the following subjects:

  (i) communication and interpersonal skills;

  (ii) infection control;

  (iii) safety and emergency procedures;

  (iv) promoting resident independence;

  (v) respecting resident rights; and

  (vi) basic nursing skills.

  (c) The trainee must complete at least 24 hours of supervised practical training in a long-term care facility, and complete all skill curriculum and skill competencies before training in any facility. The skills training must ensure that each nurse aide demonstrates competencies in the following areas:

  (i) Basic nursing skills:

  (A) taking and recording vital signs;

  (B) measuring and recording height;

  (C) caring for residents' environment; and

  (D) recognizing abnormal signs and symptoms of common diseases and conditions.

  (ii) Personal care skills:

  (A) bathing that includes mouth care;

  (B) grooming;

  (C) dressing;

  (D) using the toilet;

  (E) assisting with eating and hydration;

  (F) proper feeding techniques; and

  (G) skin care.

  (iii) Basic restorative services:

  (A) use of assistive devices in ambulation, eating, and dressing;

  (B) maintenance of range of motion;

  (C) proper turning and positioning in bed and chair;

  (D) bowel and bladder training;

  (E) care and use of prosthetic and orthotic devices; and

  (F) transfer techniques.

  (iv) Mental Health and Social Service Skills:

  (A) modifying one's behavior in response to the resident's behavior;

  (B) identifying developmental tasks associated with the aging process;

  (C) training the resident in self-care according to the resident's ability;

  (D) behavior management by reinforcing appropriate resident behavior and reducing or eliminating inappropriate behavior;

  (E) allowing the resident to make personal choices, providing and reinforcing other behavior consistent with the resident's dignity; and

  (F) using the resident's family as a source of emotional support.

  (v) Resident's rights:

  (a) providing privacy and maintaining confidentiality;

  (b) promoting the resident's right to make personal choices to accommodate the resident's needs;

  (c) giving assistance in solving grievances;

  (d) providing needed assistance in getting to and participating in resident and family groups and other activities;

  (e) maintaining care and security of resident's personal possessions;

  (f) providing care that keeps a resident free from abuse, mistreatment, or neglect, and reporting any instances of poor care to appropriate facility staff; and

  (g) maintaining the resident's environment and care through appropriate nurse aide behavior to minimize the need for physical and chemical restraints.

  (8) Qualification of Instructors:

  (a) a NATCEP must have a program coordinator who is a registered nurse with a current and active Utah license to practice;

  (b) who is in good standing with DOPL;

  (c) with two years of nursing experience, at least one of which is the provision of long-term care facility services or caring for the elderly or chronically ill of any age; and

  (d) must have at least three hours of documented consulting time per month with the respective program.

  (9) Nursing facility-based programs:

  (a) the program coordinator in a nursing facility-based program may be the director of nursing for the facility as long as the facility remains in full compliance with OBRA requirements;

  (b) the primary instructor must be a licensed nurse with a current and active Utah license to practice and must be in good standing with DOPL; and

  (c) must have two years of nursing experience, at least one of which is the provision of long-term care facility services or caring for the elderly or chronically ill of any age.

  (10) Before approval of a NATCEP, the program coordinator and primary instructor must successfully complete a UNAR-approved "Train-the-Trainer" program or demonstrate competence to teach a CNA candidate who is at least 16 years old. All high school instructors must be certified to teach in the classroom by completing a "Train the Trainer" program or be certified to teach as defined by the Utah State Office of Education before providing instruction in the classroom.

  (11) Students who provide services to residents must be under the direct supervision of a licensed nurse who is a UNAR-approved clinical instructor and whose clinical time is separate from her facility employment.

  (12) Qualified personnel from the health professions may supplement the program coordinator and primary instructor. The program coordinator or primary instructor must be present during all provided supplemental training.

  (13) Qualified personnel include registered nurses, licensed practical or vocational nurses, pharmacists, dietitians, social workers, sanitarians, fire safety experts, nursing home administrators, gerontologists, psychologists, physical and occupational therapists, activities specialists, speech or language therapists, and any other qualified personnel.

  (14) UNAR requires qualified personnel to have at least one year of current experience in the care of the elderly or chronically ill of any age, or to have equivalent experience. Qualified personnel must also meet current licensure requirements, whether they are registered or certified in their field.

  (15) A NATCEP must have a student-to-instructor ratio of 12:1 for clinical instruction and shall not exceed a 30:1 ratio for theory instruction. UNAR requires an instructor assistant when the program has more than 20 students.

  (16) A NATCEP must provide a classroom with the following:

  (a) adequate space and furniture for the number of students;

  (b) adequate lighting and ventilation;

  (c) comfortable temperature;

  (d) appropriate audio-visual equipment;

  (e) skills lab equipment to simulate a resident's unit;

  (f) clean and safe environment; and

  (g) appropriate textbooks and reference materials.

  (17) Initial post-approval and ongoing reviews:

  (a) After the initial approval of a NATCEP, UNAR grants a one-year probationary period;

  (b) During the probationary period, UNAR may withdraw program approval if there is a violation of OBRA, state, federal, or UNAR requirements;

  (c) After the probationary period, UNAR shall complete an on-site review and then complete subsequent on-site reviews at least every two years;

  (d) The CNA training program shall submit a self-evaluation to UNAR during the interim year that UNAR does not complete an on-site review;

  (e) In the event that UNAR does not complete an on-site review within two years, the CNA training program is responsible to send a self-evaluation to UNAR for the applicable two-year period;

  (f) If UNAR does not make an on-site visit within two years and the CNA training program sends in a self-evaluation, UNAR must make an on-site visit within one year of the self-evaluation.

  (18) The training and evaluation program review must include:

  (a) skills training experience;

  (b) maintenance of qualified faculty members for both classroom and skills portions of the nurse aide training program;

  (c) maintenance of the security of the competency evaluation examinations;

  (d) a record of complaints received about the program;

  (e) a record that each nursing facility has provided certified nurse aides with at least 12 hours of staff development training each year with the compensation for the training;

  (f) curriculum content that meets state and federal requirements; and

  (g) classroom facilities and required equipment that meet state, federal, and UNAR requirements.