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STATE OF TEXAS DMINISTRATOR-IN-TRAINING

INTERNSHIP MANUAL A

February, 2004

Administrator-In-Training Manual Texas Nursing Facility Administrator Program 09/01/2004 Page 1 of 45 Health and Human Services

TABLE OF CONTENTS

INTRODUCTION ....................................................................................................................................................... 2

GENERAL GUIDELINES ......................................................................................................................................... 3

HELPFUL TOPICS/ISSUES ...................................................................................................................................... 9

JOB DESCRIPTION ................................................................................................................................................. 11

SELF-ASSESSMENT TOOL ................................................................................................................................... 13

ASSIGNMENT AGREEMENT ............................................................................................................................... 21

FINAL REPORT ....................................................................................................................................................... 23

EVALUATION OF AIT’S PERFORMANCE ........................................................................................................ 30

PRECEPTOR PERFORMANCE REPORT ........................................................................................................... 31

DEPARTMENT HEAD CERTIFICATION ........................................................................................................... 33


INTRODUCTION The guidelines for the Administrator-in-Training (AIT) program of Texas have been developed to assist the Preceptor and Intern in assuring that the crucial aspects of nursing home administration are covered during the 1000 hour required schedule. By no means does it cover every experience or challenge an administrator will encounter. Rather, it is intended to expose the Intern to as much experience in basic management as possible. It should serve as a beginning to life-long learning in a career that will be both rewarding and challenging. The format has been designed to cover the five domains of practice as defined by the National Association of Boards of Examiners of Long Term Care Administrators (NAB). For purposes of training the Administrator-In-Training, an additional domain – Ethics – has been included in this program. It is hoped that this manual will be used as a basic resource and will not restrict the Intern or Preceptor in developing a learning guide that is individualized and creative. Although the Preceptor has responsibility for the training of the Intern, it is recognized that the Intern will be assigned to the directors or supervisors of various departments and will work under their direct supervision. The Preceptor, however, retains responsibility to assure a meaningful learning experience and to test the validity of knowledge and experience gained prior to certifying completion of the program. This manual is the result of the collaborative efforts of the Sub-committee on Education of the Nursing Facility Administrator’s Advisory Committee and the Health and Human Services Commission (formerly known Department of Aging and Disability Services and Texas Department of Human Services). Input and guidance was received from a number of individuals and professional organizations. Special recognition is given to Jane Baker and Regina J. Franklin, the Texas Health Care Association, Austin; Moira A Reinhardt, James L. West Center, Fort Worth; and Renee Clack, Director, Credentialing Department, Texas Department of Human Services, Austin.


State of Texas

General Guidelines for AIT program

Philosophy The State of Texas recognizes that an organized plan for the training and education of new nursing home administrators is necessary to advance the skills and expertise of those entering the profession. The Intern should realize he/she is entering a profession that requires commitment to the care of the aged and chronically ill, and that this program is only the beginning of the learning process. There must be an on-going effort to seek opportunities to increase knowledge and expertise in order to meet the ever-changing needs of those in their care. Purpose The purpose of the AIT Training Manual is to provide a program guide that will adequately prepare the Intern to operate as a licensed nursing facility administrator by taking the intern through various educational, practical and clinical experiences, and by testing the knowledge and skill gained from the experience. The manual is designed for use by both the independent preceptor, and by the preceptor of an academic setting. Length of the AIT Program The AIT program will be 1000 hours spent in a licensed facility with a minimum of 60 beds. The Intern may train for a minimum of two hours per day or more, but may not exceed 40 hours per week. The full program shall be a minimum of six months. Preceptor Qualifications and Responsibilities (non-academic) To be a preceptor a person must: • successfully complete a preceptor training under the direction of the State; • have a license that is in good standing; • recognize and assume responsibility for setting the highest ethical and professional standards

for the AIT to emulate; • be licensed as a nursing facility administrator for a minimum of five years; • hold a current license in the State of Texas for two years or more; • be the full time administrator of a licensed nursing facility; • provide the training where he/she has on-site supervisory authority and works on a daily

basis, except for specific assignments and off-site training.


• have management/corporate approval, if applicable; • agree to provide the AIT with opportunities to observe and participate in all aspects of

management; • meet with the AIT to evaluate current knowledge and experience to determine areas of

concentration during the internship; • meet regularly with the AIT and provide feedback on performance including, but not limited

to, strengths and weaknesses; • complete the necessary documentation to verify the AIT’s training; • notify the State if the AIT is out of compliance in meeting the internship requirements; • provide the State with certification that the AIT has successfully completed the required 1000

hours of internship. Preceptor Qualifications and Responsibilities (academic) To be a preceptor in the academic setting a person must: • be an instructor of an academic institution of higher education providing a baccalaureate

and/or advanced degree in Long Term Care and/or a related field; • successfully complete a preceptor training under the direction of the State; • recognize and assume responsibility for setting the highest ethical and professional standards

for the AIT to emulate; • be licensed as a nursing facility administrator for a minimum of five years; • hold a current license in the State of Texas for two years or more; • assign the AIT to the full time administrator of a facility that has been in substantial

compliance with the rules and regulations governing nursing facilities for at least the last two years, and who has a license that is in good standing.

• assure the training is provided where the administrator has on-site supervisory authority and works on a daily basis, except for specific assignments and off-site training;

• meet with the AIT to evaluate current knowledge and experience to determine areas of concentration during the internship;

• provide the administrator with the completed AIT Assignment Agreement; and instructions on how to complete the necessary documentation to verify the AIT’s training;

• meet regularly with the administrator and assure the AIT is provided with opportunities to observe and participate in all aspects of management;

• meet regularly with the AIT and provide feedback on performance including, but not limited to, strengths and weaknesses;

• notify the State if the AIT is out of compliance in meeting the internship requirements; • provide the State with certification that the AIT has successfully completed the required 1000

hours of internship.


AIT Qualifications and Responsibilities The AIT must: • be enrolled in an academic institution of higher education, completing courses towards

attainment of a bachelor’s degree in Long Term Care and/or a related filed that includes fifteen (15) academic credit hours in long term care administration which encompasses all the domains of the NAB; OR submit proof of having a bachelor’s degree in any subject and complete fifteen (15) academic credit hours in long term care administration which encompasses all the domains of the NAB;

• have submitted the required application and fees; • complete the internship in a licensed facility with a minimum of 60 beds; • have a signed agreement (AIT Assignment Agreement) with a preceptor; • be willing to apply the time and effort necessary to complete the 1000 hours of internship in

addition to any full or part time employment; • assume responsibility to obtain verification of hours completed from an assigned

administrator, director or supervisor; • be open and honest with the preceptor in discussing knowledge and experience to determine

areas of concentration during the internship; • meet with the preceptor on a regular basis and develop goals to improve any areas of

concern; • provide feedback to the preceptor and TDHS on the strengths and weaknesses of the

internship experience; • notify the State if the preceptor is out of compliance with the State regulations for Preceptors

or is not providing the required supervision. Recommendation It is recommended that fifty percent of the coursework of the 15 academic hours encompassing the five domains of NAB be completed prior to beginning the Internship. Scope of the Program It is understood that the internship will cover all of the areas of nursing facility management. The role of the preceptor, while ensuring this occurs is to act as a mentor, to be a sounding board, a teacher, a leader and an evaluator. Although the AIT will work under the supervision of others, the preceptor’s responsibility is to assure that the intern is getting the most out of the experience. The optimum expectation is that the two should meet daily, but it may be no less than once per week to maintain open communication and to assure adequate supervision and support. (This meeting would be with the on-site administrator for the AIT in the academic setting. Additional meetings with the academic preceptor, who maintains responsibility for the AIT, would be per the school’s policy). Prior to beginning the internship, the AIT will receive a copy of the job description, will be given a complete orientation to the facility and will be introduced to the directors and supervisors who will help with the training. The preceptor will give the AIT the Self-Assessment Tool to


complete on the first day of training or as part of the academic coursework. He/she will then meet with the AIT to thoroughly review the assessment, clarify strengths and weaknesses, and verify that the AIT is accurate in the assessment. Together, the preceptor and AIT will complete the AIT Assignment Agreement. The AIT will rotate through assigned departments of the facility and will spend an allocated amount of time in each of them based on the results of the self-assessment, so it is very important that sufficient time, thought and discussion are put into it. HHSC has no required number of hours that must be spent in each area, as this is dependent on the individual needs of the AIT. It is understood that this is an internship in administrative duties and the duties assigned should be such that the AIT learns leadership and management skills as well as hands on experience. Flexibility in department assignments will be necessary to allow for the unexpected learning opportunities that arise in day to day management of a nursing facility. Each administrator, department director or supervisor must complete the necessary documentation to show, not only the hours spent in the department, but also the level of knowledge gained. Any particular strengths and weaknesses must also be addressed. Similarly, the preceptor must verify the accuracy of the documentation and assist in developing a plan to correct any weaknesses before allowing the AIT to move on to another department. This can be clarified during the scheduled supervision meetings. Other It is understood that there may be occasions a facility that has been in good standing goes out of substantial compliance during an internship. Since assisting in writing a Plan of Correction and correcting deficiencies could be a learning experience for the AIT, the facility will have 60 days from notification of non-compliance to return to good standing before the internship will be affected. In the event the facility remains in non-compliance for more than 60 days the AIT must find alternate placement to complete the program. In the event that the preceptor relocates to another facility during the internship, the AIT may change to the new facility to continue the preceptor relationship, if the new facility meets the required criteria. The AIT may not transfer with the preceptor to a facility that is not in substantial compliance. The AIT may remain at the present facility under the new administrator’s supervision if the new administrator is a certified preceptor. Special Project It is not uncommon for the preceptor to assign a particular project to the AIT to be completed during the 1000 hours. This can be any one of the myriad of projects on the preceptor’s (or administrator’s) wish list. It should, however, require the AIT to demonstrate intuition and creativity, as well as leadership and administrative skills. The project should be meaningful to the AIT and useful to the preceptor and the facility.


Program Completion Upon completion of the 1000 hours of internship, the AIT again completes a Self-Assessment Tool. In addition, the preceptor also completes one, as a final evaluation of the AIT’s skill. Both should meet to compare the results, and to clarify how to correct any perceived weakness. The Preceptor then completes the Administrator-in-Training Final Report which includes a narrative report and is duly sworn and notarized before a public notary. A copy is given to the AIT and the original is sent to the Credentialing Department of HHSC, verifying the AIT’s competency to be licensed as an administrator. This must be done within 10 working days of completion of the program, or according to the academic institution’s policy. The AIT completes a Preceptor Performance Report that is duly sworn and notarized by a public notary reviewing the strengths and weaknesses of the internship experience. A copy is given to the Preceptor and the original is sent to the HHSC within 10 working days of completion of the program. The AIT may now apply for State licensure by submitting the required documentation of credentials on official HHSC forms and the appropriate fees. Documentation The following documents must be completed during the AIT’s internship: Administrator-in-Training Self-Assessment Tool; Administrator-In-Training Assignment Agreement; Department Head Certification; Administrator-in-Training Final Report; and Preceptor’s Performance Report. Upon completion of the internship, the completed forms shall be mailed to HHSC Credentialing Department. Copies of these documents are included in the manual.


Notes


HELPFUL TOPICS/ISSUES For the Administrator-In-Training Program

RESIDENT CARE MGMT PERSONNEL MGMT FINANCIAL MGMT ENVIRONMENTAL MGMT REGULATORY MGMT ORGANIZATIONAL MGMT ETHICS Policies and Procedures Policies and Procedures Policies and Procedures Policies and Procedures Policies and Procedures Policies and procedures Policies and procedures Resident Needs Role of Administration Definition of Terms Building standards Administrator’s role Ownership/Governance Mission Statement Aging Leadership Skills CFO Construction Planning, Organizing, Conflict of Interest Admission policies Diseases Unions Comptroller Maintenance Directing, Controlling, Policy Writing Discharge policies Terminology Job Descriptions Business office Preventive Maintenance Coordinating Strategic Planning Transfer policies Referrals Staffing Planning Scheduling Delegation of Duties Goal Setting Civil Rights Admissions Recruitment Capital Maintenance logs Legal responsibilities Plan Implementation Legal Discharge Interview do's Budget Development Repairs Definition of legal terms Evaluation Research Transfers and don'ts Furniture, Fixtures, and Heating & Air conditioning Joint Commission (JCAHO) Mission Statement End-of-life decisions Death Hiring policies Equipment (FF&E) Elevator maintenance Health Care Finance Admin. Philosophy of operations Advanced Directives Medical Records Labor laws Accounts Exterior care Federal, State Board/Staff Relations POA/ DPOA/ Guardian Resident’s rights Reference checks Problems Requiring Math Grounds maintenance and City Regulations Corporate Relations Living Wills Advanced Directives Criminal records Occupancy Ratios Equipment Licensing Standards Organizational Chart Nutrition and Hydration Infection Control Emloyment contracts Budget Controls Asset replacement budget Conditions of Participation Public Relations Withholding or Universal Precautions Salary negotiation Revenue Sources Vendor Contracts Surveys and Complaints Marketing Withdrawing treatments Weight loss protocols Benefits program Fixed Assets Pest control Informal Dispute Resolution Resident Source Marketing/Advertising Safety and Security Supervision Variable assets Fire and Disaster Deficiencies Admission Policies Materials Smoking policy Orientation Fixed Costs Safety Plan of Correction Annual resident days Administrator's Physical Assessment On-the-job training Variable Costs Emergency Plans Compliance by Payment Source Compensation and Schedule Cont. Education/ Insurance Evacuation Maps Special Care Units Average length of stay Staff Relations MDS forms In-Services Taxes Life Safety Code Insurance Turnover Rates Wage/Salary Care Plans Retention Profit/Loss Major Accident Hazards Title VI Ethics Committee administration Staffing Performance Review Cost Accounting Safety Committee Title VII Research Policies Staff morale Dietary Timekeeping Cash Accounting Security Title XVIII Total Quality Mgmt. (TQM) Grievance procedures Nutrition/snacks Absenteeism Accrual Process Cleaning routines Title XIX Lawsuits Recruitment Hiring Activities Corrective Action Statements Chemical Use Title XXII practices Social services Sexual Harassment Trust Funds Housekeeping Safe Medical Device Act Conflict of Interest Nursing Discrimination Receivables Sanitation Incidents and Accidents Contracting Policies Medical Director Duties Nepotism policy Payables Laundry Resident Abuse Reporting Fraud and Abuse Physician visits Grievance Purchasing Hot water temperatures Family Leave Act Standing Orders Employee assistance Purchase Order Reports Civil Rights Restraints Morale Inventory Smoke-detector & Residents Rights Pharmacy Motivation Vendor Contracts Sprinkler Maintenance Worker’s Compensation Drug Control Timekeeping Bio-Hazard Materials Medicaid Services Contract Services Wages Isolation Medicare Insurance Payroll Universal Precautions/ Fiscal Itermediary Utilization- Review/QA Garnishment Infection Control Reimbursement guidelines

HELPFUL TOPICS/ISSUES For the Administrator-In-Training Program


RESIDENT CARE MGMT PERSONNEL MGMT FINANCIAL MGMT ENVIRONMENTAL MGMT REGULATORY MGMT ORGANIZATIONAL MGMT ETHICS Positive Family involvement

Uniform Cost Report MSDS forms EEOC

Complaint reduction Break-Even Analysis OSHA ADA Health status of resident Current Ratio EPA OBRA Theft and Abuse Depreciation schedules NFPA COBRA Suicide Precautions Resident Charges Fire Drills OSHA Fall Prevention program Liquidity Fire Control Section 504 Volunteer Program Net Worth Emergency Equipment Equal Pay Act 1963 Hospice Retained earnings Back-up generator Dementia care Journal Behaviour problems Ledger Skin Care protocols Reconciliation Documentation Trial Balance Fire Drills/Evacuation Tax Forms Malpractice Investments

Dividends Amortization Schedule Balance Sheet


ADMINISTRATOR-IN-TRAINING JOB DESCRIPTION

Job Title: Administrator-in-Training Department: Administration Effective Date: June 1999 POSITION SUMMARY The Administrator-in-Training (AIT) will complete the required 1000 hours of training in long term care administration, becoming familiar with the Standards of Practice for Administrators and achieving a level of competency in the oversight of all departments of the facility. SUPERVISION 1. Received: General supervision from the Preceptor. Receives day-to-day supervision from

the Administrator or Department Head of the assigned department. 2. Given: Will assist Department Head in the general supervision of personnel within the

assigned department, during each rotation. INTERPERSONAL RELATIONSHIPS Ability to deal effectively and tactfully with facility staff, physicians, residents, families and visitors. Skill in interviewing, evaluating and advising. Ability to make accurate assessment of situations. Access to medical records without direct supervision. Deals with significant confidential information from physicians, nurses, residents, families, staff and other entities. MENTAL AND PHYSICAL EFFORT Mental Effort: Ongoing assessment, evaluation, analysis, planning, problem solving, and flexibility in making judgements regarding all aspects of nursing home administration. Ability to integrate diverse forms of information into a coherent whole. Ability to maintain confidentiality. Ability to interpret and implement the rules and regulations governing nursing facilities. Ability to remain calm in the midst of real or perceived chaos and to handle a large number of projects simultaneously. Personal maturity, integrity and sound judgement. Physical Effort: Manual dexterity, verbal skills, ability to write information clearly, accurately, and rapidly. Ability to understand and to operate the Fire Alarm System in a reassuring manner. Must be capable of assisting with or directing the evacuation of the facility in case of fire or disaster. May be exposed to contagious diseases and/or hazardous materials. May be required to lift heavy objects with or without assistance.


IMPACT Must have a management style that is service oriented, with an awareness of, and a willingness to utilize the strengths of an interdisciplinary team of staff, volunteers and families, recognizing the importance of each. RESPONSIBILITIES 1. Complete the Self-Assessment Tool and develop an AIT plan with the Preceptor. 2. Become familiar with the Standards of Practice for Long Term Care Administrators. 3. Become familiar with the job descriptions and leadership responsibilities of the Department

Heads and assume an active leadership role as their assistant. 4. Actively participate in management decisions during problem solving sessions. 5. Become familiar with the myriad of duties to be accomplished within a nursing facility to

provide the highest quality of care. 6. Understand the contribution each position within the facility makes to the overall success of

the program. 7. Conduct daily rounds using eyes, ears, and nose, and report any concerns or problems to the

appropriate department manager. Follow up to assure a solution is reached. 8. Chair at least one committee meeting in each department to learn the different ways and

means to reach consensus. 9. Present at least one continuing education program relating to Ethics, and others as assigned. 10. Assist in the (a) admission (b) discharge of a resident. 11. Attend care plans during the rotation in Nursing, Social Services, Dietary and Activities

departments to understand the key role each plays in resident care. 12. Read the 24-hour Report and Weight Loss Report and make recommendations to assure

positive outcomes, paying particular attention to skin integrity. 13. Manage one complaint/incident investigation (real or simulated) from report to completion. 14. Conduct a mock survey of each department during the rotation and report deficiencies, and

plans of correction, to the Department Head. 15. Develop a staff scheduling log (real or mock) for one month. 16. Become familiar with accounting tasks such as, but not limited to, accounts payable,

receivables, setting up trust funds, logging to the general ledger etc. 17. Complete daily log of hours for Department Head verification and signature. 18. Complete any additional assignments or readings from the preceptor. 19. Meet with the preceptor on a scheduled basis but no less than once per week for supervision

and to problem solve areas of concern. 20. Complete a final report of the internship and an evaluation of the preceptor. OTHER The intent of this job description is to provide a guide to the AIT of what is expected during the 1000-hour internship. It is by no means all-inclusive. The AIT can be creative and enthusiastic and go beyond these job tasks, under the supervision and direction of the Preceptor, to gain the maximum experience possible.


ADMINISTRATOR-IN-TRAINING SELF-ASSESSMENT TOOL

AIT NAME DATE

FACILITY

PRECEPTOR NAME LICENSE NO. This Tool has been developed to assist you and your preceptor in developing the most appropriate training schedule, based on your individual needs. It is imperative that you be honest in your assessment. It is not a test. It is to be used by you to evaluate your individual knowledge base of nursing facility administration. From this, you and your preceptor will develop a program that concentrates on your areas of greatest need. This will enable you to receive the greatest benefit from the internship, with the goal of adequately preparing you for the many challenges you will encounter as a nursing facility administrator. Please complete the following information.

EDUCATION Name of School Degree received Years

completed Undergraduate

College

Graduate/ Professional

Other (Specify)

OTHER QUALIFICATIONS, SKILLS OR TRAINING

List any experience or job-related skill that may be applicable to nursing facility management


Self-assessment continued Please place a check √ in the box that best describes your knowledge or skill. Ask yourself, “how knowledgeably am I in this particular area and would my knowledge stand the test if questioned?” Rate yourself as follows: (1) Nothing, (2) Some, (3) Knowledgeable, (4) Very knowledgeable 1. ADMINISTRATION and MANAGEMENT 1 2 3 4

A. General 1. Ownership of facility

2. Governing body make-up and duties 3. Administrator's duties & authority

4. How policy is made 5. Policy and procedures manual

6. Value and use of staff meetings 7. How to develop program plans

8. How to organize tasks & employees Into departments (organizational chart)

9. How to direct employees 10. Community resources available

11. Marketing and public relations 12. Ethics and malpractice

13. Eviction of residents 14. Power of attorney

15. Advanced directives 16. Complaint investigation

17. Incident/abuse reporting 18. License survey process

B. Personnel Management

1. Personnel policy and procedures 2. Salary scales and fringe benefits

3. Preparing and using job descriptions 4. Employment practices

5. Employee records 6. Orientation and in-service training

7. Disciplinary measures 8. Staffing

9. Employee counseling 10. Grievance procedures 11. Procedures for sitters

12. Pre-employment exams and health requirements

13. Performance evaluations 14. Employee recognition and awards

program

15. Organized labor (NLRB) 16. Fair labor standards provisions

17. COBRA regulations

C. Business Office Management 1. Standards of payment


Self-assessment continued

1 2 3 4

2. Accounting system used, accrual 3. Cash journals, ledgers

4. Accounts receivable and resident rates 5. Accounts payable

6. Leases and contracts 7. Payroll accounting and tax reports

8. Budget preparation 9. Insurance

10. Assets and liabilities 11. Depreciation

12. Use of bids and quotes 13. Financial reports

14. Operating office machines 15. Audits

16. Purchasing procedures 17. Petty cash

18. Property control system 19. Employee expense accounts

20. Retirement plans 21. Taxes

22. Garnishments 23. Internal controls

24. Cost containment practices

D. Government Relations 1. Health Care Finance Administration

2. HCFA - OBRA regulations 3. Drug Enforcement Administration

4. ANSI Standards 5. Life Safety Code 6. OSHA standards

7. Wage and Hour Administration 8. Americans with Disabilities Act

9. Ombudsman program 10. NFA Advisory Committee

11. Long Term Care Regulatory 12. Texas Department of Human Services

II. NURSING SERVICE

A. Staffing requirements 1. RN's, LVN's, CNA's

2. Scheduling 3. Medical director

B. Nursing Policies and Procedures

C. Interdisciplinary team make-up, duties

1. Admission of resident 2. Assessment, reassessment 3. Comprehensive plan of care


Self-assessment continued 1 2 3 4

4. Documentation and charting D. Nursing care

1. Bathing, grooming 2. Skin care, care of decubitus

3. Ambulating, body mechanics 4. Feeding

5. TPR and B/P 6. Oral hygiene

7. Use of catheters 8. Use of restraints

9. Bowel and bladder training 10. Other nursing procedures

11. Weight loss – assessment and impact 12. Pressure sores/intervention

13. Falls precautions

E. Rehabilitation services 1. PT, OT, ST, other 2. Restorative Care

3. Psych. Evaluation/treatment

F. Medications 1. Storage - external, internal, Schedule II

2. Administration 3. Disposal – routine and Schedule II

4. Medication errors 5. Unnecessary drugs 6. Psychotropic drugs

7. PRN orders

G. Resident incident and accident reports

H. Handling emergencies – transfer

I. Isolation

J. Care of deceased

K. Counseling resident/family

L. Quality assessment committee

M. Discharge and transfer

N. Evaluating nursing service

O. Peer Review

III. MEDICAL RECORDS

A. Staffing requirements



B. The medical record 1. Contents

2. Sequence in filing 3. Charting errors – corrections

4. Thinning charts

C. Ownership 1. Resident access to records

2. If facility is sold

D. Filing system 1. Checking in and out

2. Storage and security

E. Federal and state regulations 1. Retention of records

2. Confidentiality 3. Release of information

F. Closing a medical record

G. Evaluating the medical records

program

IV. DIETARY


B. State, County, City Regulations 1. Dress requirements

2. Health cards

C. Menus and records 1. Therapeutic diets

2. Retention of records

D. Purchasing, receiving, storage 1. Procedures for purchasing

2. Receiving reports 3. Storage and temperatures

E. Issuing from storeroom, security

F. Food preparation and serving

1. Dining area – cleaning 2. Serving, food carts, food trays

3. Portions/snacks/presentation/supplements 4. Temperatures of hot/cold food

G. Dietary equipment – care and upkeep

H. Sanitation

1. Preventing disease spread



2. Hand-washing facilities 3. Dishwashing

4. Garbage storage and disposal 5. Pest control

I. Prevention and control of grease fires

J. Monitoring and evaluating food

service

V. RESIDENT ACTIVITIES


B. Planning resident activities 1. Determining capabilities

2. Checking physician orders 3. Scheduling events

4. Coordination with Nursing, Dietary, etc.

C. Carrying out activities 1. Proper techniques with residents

2. Group activities 3. Exercising residents 4. Motivating residents

5. Arts and crafts 6. In-room activities

D. Working with resident council

E. Arranging religious services

F. Interdisciplinary team role

G. Records

H. Community activity resources

I. Special events

J. Evaluation of program effectiveness

VI. SOCIAL SERVICE

A. Social worker qualifications & duties

B. Social histories & records

C. Interviewing new residents & families

D. Community resources to meet resident needs

E. Interdisciplinary team role



F. Handling residents' personal needs

G. Resident counseling techniques

H. Family problems and counseling

I. Discharge planning role

J. Evaluating social service

VII. ENVIRONMENTAL

A. Housekeeping 1. Staffing needs & schedules

2. Cleaning schedules 3. Procedures for cleaning

4. Procedures for odor control 5. Use and care of equipment

6. MSDS sheets

B. Laundry 1. Linen requirement

2. Handling soiled linen 3. Linen storage and control

4. Transporting of linens 5. Laundry procedures

6. Use and care of equipment 7. Determining costs

C. Maintenance

1. Emergency power requirements 2. Preventive maintenance program

3. Equipment repair procedures 4. Heating, cooling and water systems

5. Pest control system 6. Trash disposal

7. Security program 8. Grounds maintenance

9. Parking regulations 10. Energy cost control measures

11. Testing the back-up generator

D. Fire and disaster 1. Fire prevention and control

2. Disaster plan 3. Fire drill schedule

E. Safety and Health

1. OSHA 2. Infection control

3. Employee health 4. Hepatitis B vaccinations 5. Tuberculosis regulations



6. Workplace violence 7. Safety

8. Smoking policies 9. Safe Medical Devices Act

10. Lockout Tag-out VIII. ETHICS

1. Advance Directives 2. DNR/end of life decisions

3. Withholding/withdrawing treatment 4. Hydration and Nutrition

Hospice 5. Staff Relations 6. Facility policies

Administrator-in-Training Signature Date

Preceptor Signature Date


ADMINISTRATOR-IN-TRAINING ASSIGNMENT AGREEMENT

AIT NAME DATE

PRECEPTOR NAME LICENSE NO

FACILITY ADDRESS

PHONE NUMBER VENDOR NUMBER

STARTING DATE COMPLETION DATE

TOTAL NUMBER OF WEEKS TO COMPLETE PROGRAM

DEPARTMENT ASSIGNMENT

BEGINNING DATE

ASSIGNED HOURS

DEPT. HEAD

ADMINISTRATION

NURSING SERVICE

MEDICAL RECORDS

DIETARY

RESIDENT ACTIVITIES

SOCIAL SERVICES

ENVIRONMENTAL SERVICES

ETHICS

OTHER e.g. Corporate Office, Other facilities etc.

I hereby agree with, and understand, that I must successfully complete all the above assignments in order to fulfill the HHSC Administrator-in-Training Program requirements. I understand flexibility with assignments will be necessary while obtaining the required hours in order to allow for unexpected opportunities for learning.

PRECEPTOR SIGNATURE

ADMINISTRATOR-IN-TRAINING SIGNATURE


Notes

Administrator-In-Training Manua1 Texas Nursing Facility Administrator Program 09/01/2004 Page 23 of 45 Health and Human Services

ADMINISTRATOR-IN-TRAINING FINAL REPORT

NAME DATE

ADDRESS

FACILITY NAME LICENSE NO.

PRECEPTOR NAME LICENSE NO. INSTRUCTIONS: The Preceptor must complete the date and number of hours showing the AIT had time and experience in that area. Based on the AIT’s Self-Assessment, there will be activities he/she did not need to cover in the rotation. The Preceptor must date and initial the areas in which the AIT had prior experience and competence, verifying his/her knowledge base prior to you beginning the rotation.

RESIDENT CARE MGMT Date completed

No. of Hours Preceptor Initials

Policies and Procedures

Resident Needs

Aging

Diseases

Terminology

Referrals

Admissions

Discharge

Transfers

Death

Medical Records

Resident’s rights

Advanced Directives

Infection Control

Universal Precautions

Weight loss protocols

Safety and Security

Physical Assessment and schedule

MDS forms

Care Plans

Staffing

Dietary

Nutrition/snacks


Final Report continued Date

Completed No of Hours Preceptor

initials

Activities

Social services

Nursing

Medical Director Duties

Physician visits

Standing Orders

Restraints

Pharmacy

Drug Control

Contract Services

Insurance

Utilization- Review/QA

Fire Drills/Evacuation

Positive Family involvement

Health status of resident

Theft and Abuse

Suicide Precautions

Fall Prevention program

Volunteer Program

Hospice

PERSONNEL MGMT


Role of Administration

Leadership Skills

Unions

Job Descriptions

Staffing

Recruitment

Interview do's and don’ts

Hiring

Labor laws

Retention

Supervision

Sexual Harassment

Discrimination

Orientation

On-the-job training


Final report continued Date


initials

Mandatory In-Services

Performance Review

Timekeeping

Wages

Absenteeism

Corrective Action

Grievance

Employee assistance

Morale

Motivation

FINANCIAL MGMT


Definition of Terms

CFO

Comptroller

Business office

Planning

Capital

Budget Development

Furniture, Fixtures, and Equipment (FF&E)

Names of Accounts

Problems Requiring Math

Occupancy Ratios

Budget Controls

Revenue Sources

Fixed Assets

Variable assets

Fixed Costs

Variable Costs

Insurance

Taxes

Profit/Loss

Cost Accounting

Cash Accounting

Accrual Process

Statements

Trust Funds


Final Report Continued

Date Completed

No of Hours

Preceptor initials

Receivables

Payables

Purchasing

Purchase Order

Inventory

Vendor Contracts

Timekeeping

Wages

Payroll

Garnishment

Uniform Cost Report

Break-even Analysis

Current Ratio

Depreciation schedules

Resident Charges

Liquidity

Net Worth/Retained Earnings

Journal

Ledger

Reconciliation

Retained earnings

Trial Balance

Tax Forms

Dividends

Amortization Schedule

Balance Sheet

ENVIRONMENTAL MGMT


Building standards

Construction

Maintenance

Preventive Maintenance

Scheduling

Maintenance logs

Repairs

Heating & Air conditioning

Elevator maintenance

Exterior care




initials

Grounds maintenance

Equipment

Asset replacement budget

Vendor contracts

Pest control

Fire and Disaster

Safety

Emergency Plans

Evacuation maps

Life Safety Code

Major Accident Hazards

Safety Committee

Security

Cleaning routines

Chemical use

Housekeeping

Sanitation

Laundry

Reports

Smoke-detector &Sprinkler maintenance

Bio-Hazard Materials

Isolation

Universal Precautions/

Infection Control

ANSI

OSHA

EPA

NFPA

Fire drills

Fire control

Emergency equipment

REGULATORY MGMT


Administrator’s role

Planning, Organizing,

Directing, Controlling,

Coordinating




initials

Delegation of Duties

Legal responsibilities

Definition of legal terms

Organizational Charts

Joint Commission (JCAHO)

Federal Regulations

State Regulations

Licensing Standards

Conditions of Participation

Surveys and Complaints

Informal Dispute Resolution

Compliance

Deficiencies

Plan of Correction

Insurance

Title VI

Title VII

Title XVIII

Title XIX

Title XXII

Safe Medical Device Act

Incidents and Accidents

Resident Abuse Reporting

Family Leave Act

Civil Rights

Residents Rights

Worker’s Compensation

Medicaid Services

Medicare

Fiscal Intermediary

Reimbursement guidelines

Equal Pay Act 1963

Section 504

EEOC

ADA

OBRA

COBRA

OSHA

Local Survey and Regulatory Agencies




initials ORGANIZATIONAL MGMT

Policies and procedures

Ownership/Governance

Policy Writing

Strategic Planning

Goal Setting

Plan Implementation

Evaluation

Mission Statement

Philosophy of operations

Organizational Chart

Public Relations

Marketing

Resident Source

Admission Policies

Annual resident days by Payment Source

Average length of stay

Turnover Rates

Ethics Committee

Research Policies

Total Quality Mgmt. (TQM)

ETHICS

Policies and procedures

Mission Statement

Admission policies

Discharge policies

Transfer policies

Civil Rights

Legal

Research

End-of-life decisions/Hospice

Advanced Directives

POA/ DPOA/ Guardian

Living Wills

Nutrition and Hydration

Withholding or Withdrawing Treatments

Marketing/Advertising Materials

Staff Relations


Final Report Continued

Wage/Salary Administration

Staff morale Recruitment Hiring Practices

Conflict of Interest Contracting Policies

EVALUATION OF AIT’S PERFORMANCE

NARRATIVE: To be completed by the Preceptor

CERTIFICATION OF EXPERIENCE I hereby certify that _____________________________________ has completed 1000 hours of training in the above referenced areas, in accordance with the AIT guidelines, and that in my judgement he/she is capable of performing competently as an administrator.


Administrator-in-Training Signature Date State of Texas § County of § Before me, a notary public, on this day personally appeared , known to me (or proved to me on oath of ) to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he/she executed the same for the purpose and consideration therein expressed. Given under my hand and seal of this office this day of , (year).

Notary Public, State of Texas

(Personalized Seal)


PRECEPTOR PERFORMANCE REPORT (To be completed by the Administrator-in-Training at the end of the internship)

Name of Preceptor License No. Facility Name and Address Phone Number Vendor No. Date Internship Began Ended The goal of this evaluation is to provide feedback to the preceptor on the strengths and weaknesses of the internship. It is also to assist the Texas Health and Human Services in assuring adequate training for future AITs. It is important that the AIT answer the questions as objectively as possible. A copy of the completed Evaluation shall be given to the Preceptor and the original mailed to the Credentialing Department of the Texas Health and Human Services after it has been sworn and notarized by a public notary. 1. Did the Preceptor conduct an initial interview to review and verify the AIT Self- Assessment? Yes No (explain) 2. Did you have adequate input into your AIT Assignments? 3. Did the preceptor conduct an adequate orientation to the facility and staff? Yes No (explain) 4. Did the department heads provide adequate training and supervision? If not, was the preceptor responsive to your concerns? 5. How often did you meet with your preceptor? 6. Was your preceptor actively involved in your training and available for consultation when necessary?


7. Give a brief analysis of any positive experience or problem encountered during the internship. 8. Overall how would you rate your experiences? Excellent Very Helpful Helpful Unsatisfactory 9. Would you recommend this preceptor to another AIT? Yes If no, explain 10. Additional comments


Administrator-in-Training Signature Date State of Texas § County of § Before me, a notary public, on this day personally appeared , known to me (or proved to me on oath of ) to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he/she executed the same for the purpose and consideration therein expressed. Given under my hand and seal of this office this day of , (year).

Notary Public, State of Texas

(Personalized Seal)


DEPARTMENT HEAD CERTIFICATION

This Tool is to be completed by the department head/manager who has direct supervision of the AIT during the department rotation. The department head/manger’s role in the AIT Program is key to the success of the internship. His/her leadership, guidance and enthusiasm will provide an example the intern can strive to emulate. An AIT internship is designed to expose the candidate to hands-on day to day management of the department. In addition, he/she should be encouraged to tackle as many challenging experiences as possible. Prior to beginning the rotation, the intern completes a self-assessment of present skills and experience and has this verified by the Preceptor (Administrator). From the self-assessment and discussion with the AIT, the Preceptor then designs an individualized learning guide for the AIT in the departments in which the AIT needed training (the AIT Assignment Agreement). Attached is a copy of the Assignment Agreement. The Assignment Agreement has been signed by the AIT, specifying the various departments in which the AIT will rotate, the beginning date of the rotation and the number of hours required in that department. Note that no end date is assigned to allow for unexpected opportunities for learning throughout the entire internship. In order to maximize the AIT’s experience, it will be necessary for department heads to be flexible with the rotation so that the AIT may come and go from a department if the need arises. For example, if the AIT is rotating through Social Services and a survey team arrives unannounced, the AIT should be encouraged to participate in all departments during the survey. The AIT and the department head should keep track of the number of hours and the various experiences gained in that department in order to complete the Department Head Certification form. It is important to remember that the AIT internship is designed to expose the intern to leadership and management experience. Some hands on experience will be required, but the goal is to help the intern become a competent administrator who understands the process of planning, organizing, directing, controlling and coordinating. The certification form covers many topics, some of which the intern has previous knowledge or experience. The department head should only sign off on those areas covered during the rotation. In completing the section on strengths and weaknesses, be specific and succinct. This will help the Preceptor develop a plan to assist the intern in correcting any weaknesses before they move to another department.


Notes


ADMINISTRATION

A. General Administration and Management Date No of Hours Initials

1. Ownership of facility 2. Governing body make-up and duties 3. Administrator's duties & authority 4. How policy is made 5. Policy and procedures manual 6. Value and use of staff meetings 7. How to develop program plans 8. How to organize tasks & employees into departments (organizational chart)

9. How to direct employees 10. Community resources available 11. Marketing and public relations 12. Ethics and malpractice 13. Eviction of residents 14. Power of attorney 15. Advanced directives 16. Complaint investigation 17. Incident and Abuse reporting 18. License survey protocol

B. Personnel Management 1. Personnel policy and procedures 2. Salary scales and fringe benefits 3. Preparing and using job descriptions 4. Employment practices 5. Employee records 6. Orientation and in-service training 7. Disciplinary measures 8. Staffing 9. Employee counseling 10. Grievance procedures 11. Procedures for sitters 12. Pre-employment exams and health requirements 13. Performance evaluations 14. Employee recognition and awards program 15. Organized labor (NLRB) 16. Fair labor standards provisions 17. COBRA regulations

C. Business Office Management 1. Standards of payment 2. Accounting system used, accrual 3. Cash journals, ledgers 4. Accounts receivable and resident rates 5. Accounts payable 6. Leases and contracts 7. Payroll accounting and tax reports 8. Budget preparation


Administration continued Date No of Hours Initials 9. Insurance 10. Assets and liabilities 11. Depreciation 12. Use of bids and quotes 13. Financial reports 14. Operating office machines 15. Audits 16. Purchasing procedures 17. Petty cash 18. Property control system 19. Employee expense accounts 20. Retirement plans 21. Taxes 22. Garnishments 23. Internal controls 24. Cost containment practices

D. Government Relations 1. Health Care Finance Administration 2. HCFA - OBRA regulations 3. Drug Enforcement Administration 4. ANSI Standards 5. Life Safety Code 6. OSHA standards 7. Wage and Hour Administration 8. Americans with Disabilities Act 9. Ombudsman program 10. State Board of NFA examiners 11. Long Term Care Regulatory 12. Texas Department of Human Services

I certify I have undergone training in the above department in accordance with the AIT guidelines.

Administrator in Training Signature

I hereby certify that I have completed the assigned hours of training of the above mentioned AIT.

Strengths:

Weaknesses:

Date Department Head Signature


NURSING SERVICE

A. Staffing requirements Date No of Hours Initials

1. RN's, LVN's, CNA's 2. Scheduling 3. Medical director

B. Nursing Policies and Procedures

C. Interdisciplinary team make-up, duties 1. Assessment, reassessment 2. Comprehensive plan of care

D. Nursing care 1. Bathing, grooming 2. Skin care, care of decubitus 3. Ambulating, body mechanics 4. Feeding 5. TPR and B/P 6. Oral hygiene 7. Use of catheters 8. Use of restraints 9. Bowel and bladder training 10. Other nursing procedures 11. Weight loss -- assessment and impact 12. Pressure sores/intervention 13. Falls precautions

E. Rehabilitation services 1. PT, OT, ST, other 2. Restorative care

F. Medications 1. Storage - external, internal, Schedule II 2. Administration 3. Disposal - routine and Schedule II 4. Medication errors 5. Unnecessary drugs 6. Psychotropic drugs 7. PRN orders

G. Resident incident and accident reports

H. Handling emergencies - transfer

I. Isolation

J. Care of deceased

K. Counseling resident/family


Nursing Service continued Date No of Hours Initials L. Quality assessment committee

M. Discharge and transfer

N. Evaluating nursing service

O. Peer Review

I certify I have undergone training in the above department in accordance with the AIT guidelines. Administrator in Training Signature


Strengths:

Weaknesses:



Medical Records

Date No of Hours Initials A. Staffing requirements

B. The medical record 1. Contents 2. Sequence in filing 3. Charting errors – corrections 4. Thinning of the chart

C. Ownership 1. Resident access to records 2. If facility is sold

D. Filing system 1. Checking in and out 2. Storage and security

E. Federal and state regulations 1. Retention of records 2. Confidentiality 3. Release of information

F. Closing a medical record

G. Evaluating the medical records program


I hereby certify that I have completed the assigned hours of training of the above mentioned AIT. Strengths:

Weaknesses:



DIETARY


B. State,County,City health requirements 1. Dress requirements 2. Health cards

C. Menus and records 1. Therapeutic diets 2. Retention of records

D. Purchasing, receiving, storage 1. Procedures for purchasing 2. Receiving reports 3. Storage and temperatures

E. Issuing from storeroom, security

F. Food preparation and serving 1. Dining area - cleaning 2. Food carts, food trays 3. Serving/portions/snacks 4. Temperatures of hot/cold food

G. Dietary equipment -- care and upkeep

H. Sanitation 1. Preventing disease spread 2. Handwashing facilities 3. Dishwashing 4. Garbage storage and disposal 5. Pest control

I. Prevention and control of grease fires

J. Monitoring and evaluating food service



I hereby certify that I have completed the assigned hours of training of the above mentioned AIT. Strengths:

Weaknesses:



RESIDENT ACTIVITIES


B. Planning resident activities 1. Determining capabilities 2. Checking physician orders 3. Scheduling events 4. Coordination with Nursing, Dietary, etc.

C. Carrying out activities 1. Proper techniques with residents 2. Group activities 3. Exercising residents 4. Motivating residents 5. Arts and crafts

D. Working with resident council

E. Arranging religious services

F. Interdisciplinary team role

G. Records

H. Community activity resources

I. Special events

J. Evaluation of program effectiveness




Strengths:

Weaknesses:



SOCIAL SERVICE

Date No of Hours Initials

A. Social worker qualifications & duties

B. Social histories & records

C. Interviewing new residents & families

D. Community resources to meet resident needs

E. Interdisciplinary team role

F. Handling residents' personal needs

G. Resident counseling techniques

H. Family problems and counseling

I. Discharge planning role

J. Evaluating social service



Strengths:

Weaknesses:



ENVIRONMENTAL SERVICES

Date No of Hours Initials A. Housekeeping 1. Staffing & scheduling 2. Cleaning schedules 3. Procedures for cleaning 4. Procedures for odor control 5. Use and care of equipment 6. Safety and security of the housekeeping cart 7. Handling of contaminated materials 8. Wet Floor Signs 9. Furniture placement/exit access

B. Laundry 1. Linen requirement 2. Handling soiled linen 3. Linen storage and control 4. Transporting of linens 5. Laundry procedures 6. Use and care of equipment 7. Water Temperatures 8. Handling of contaminated clothing and linens

C. Maintenance 1. Emergency power requirements 2. Preventive maintenance program 3. Equipment repair procedures 4. Heating, cooling and water systems 5. Pest control system 6. Trash disposal 7. Security program 8. Grounds maintenance 9. Parking/parking space regulations 10. Energy cost control measures 11. Testing back-up generator schedule 12. Inspection and tagging of residents' electronics 13. Work orders 14. Temperature logs 15. Outside contractor/vendor supervision

D. Fire and disaster 1. Fire prevention and control 2. Disaster plan 3. Inspection and tagging of fire extinguishers 4. Fire Drills

E. Safety and Health 1. OSHA requirements 2. Infection control 3. Employee health 4. Hepatitis B Vaccinations


Environmental Services continued Date No of hours Initials

5. Tuberculosis regulations 6. Workplace violence 7. Safety 8. Safe Medical Devices Act 9. MSDS sheets 10. Role of Safety Committee 11. Lockout tag-out




Strengths:

Weaknesses:



ETHICS

Date No of Hours Initials 1. Mission Statement 2. POA/DPOA/Guardian 3. Advance Directives 4. DNR and End-of-Life Decisions 5. Research 6. Admission and Discharge Policies 7. Living Wills 8. Nutrition and Hydration 9. Withholding or Withdrawing Treatments 10. Transfer Policies 11. Civil Rights 12. Marketing and Advertising materials 13. Staff Relations 14. Wage/Salary administration 15. Recruiting/Hiring practices 16. Conflict of Interest 17. Contracting Policies 18. Legal 19. Ethics Committee 20. Resident's Rights




Strengths:

Weaknesses:


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