Program Renewal Application Date: / /

Transcription

1 Program Renewal Application Date: / / NATCEP * Renewal Due Date: / / PLEASE ENCLOSE: Program Renewal Site Survey ($110) Self-Survey ($0) First Year Site Survey ($0) Primary Site Info Phone Number: ( ) - Alternate Phone Number: ( ) - Initial Program Approval Date: Program Hours*: Theory: Clinical: Total: *100-hour minimum required, 24 hours of which must be clinical Title and publisher of primary textbook(s) or other commercial training material used: Owner/Administrator Contact Info Phone Number: ( ) - Alternate Phone Number: ( ) - Program Coordinator Contact Info Phone Number: ( ) - Alternate Phone Number: ( ) - *This application and all supporting documents must be received in the UNAR office by the 20 th of the month prior to program renewal and/or self-survey due date.

2 The following assurances are part of the renewal process for Nursing Assistant Training and Competency Evaluation Program (NATCEP) approval. Program renewal is not automatic. 1. Program is familiar with and abides by all federal regulations, state rules, and Utah Nursing Assistant Registry policy. Any violation may result in withdrawal of program approval or denial of program renewal. 2. All teaching and clinical staff receive UNAR approval prior to assuming any teaching or teaching assistant duties. 3. Qualified personnel who meet Utah Administrative code R (13) (14) are utilized in the classroom only if UNAR approved instructor is present during all supplemental training provided. 4. Student/instructor ratio is not greater than 20:1 or 30:2 for theory instruction. 5. Student/instructor ratio is not greater than 12:1 in clinical experience. 6. Student/Certified Nursing Assistant ratio is not greater than 1:1 in clinical experience. 7. All nursing assistants that students are paired with are certified. 8. Each candidate enrolled in the nursing assistant training program is identified as a nursing assistant student during all aspects of the clinical education program and not utilized as staff while in clinical. 9. Nursing assistant students do not perform any skills that they have not been trained and verified as competent by the instructor to perform. 10. A nursing assistant who is employed by or has received an offer of employment from a Long Term Care Nursing Facility on the date on which the aide begins a Nursing Assistant training program may not be charged for any portion of the program including; any fees, textbooks or other required course material(s). (Applies to facilities and agencies receiving Medicare and/or Medicaid funds, who are under the OBRA mandate) 11. If a nurse aid becomes employed by or receives an offer of employment within 12 months of completing a NATCE program, the employing nursing facility is required to reimburse new employee for all program costs including tuition, fees, textbooks, and other required course materials on a 12-month pro-rated basis. (Applies to facilities and agencies receiving Medicare and/or Medicaid funds, who are under the OBRA mandate) 12. The classroom, including a learning lab with all required equipment, provides an adequate learning environment. 13. Each student receives information regarding program completion requirements and expectations, student grievances, refunds, attendance, make-up time, and dismissal policies. 14. The UNAR State Curriculum for nursing assistant training programs is followed. 15. The course is designed in a format which has measurable cognitive and behavioral objectives that meet OBRA training and UNAR requirements. 16. The students are taught and practice more than 70 nursing skills in class. 17. Each student completes a minimum of 100 hours of training within the program, at least 24 of these hours are clinical. 18. No classroom or clinical hour credit is given for any student for time spent working with or without pay, outside of the NATCEP in any health-related or other work environment. 2

3 19. Program staff submit the names of all graduates of the approved nursing assistant training program at the time of program completion. 20. The primary source of communication from UNAR is in form. The NATCEP is held liable for all information sent via the and physical addresses documented on this form and thus is expected to provide updates as necessary to UNAR. 21. Any changes and rationale for the change in the NATCEP must be sent to the UNAR prior to implementation, to include, but not limited to: significant change in curriculum change in physical location of training change in clinical sites change in program coordinator, primary instructor, classroom or clinical instructor change in ownership of program/company /address/phone changes of owner and program coordinator I attest that our program is following all requirements as stated above: Type or Print Administrator Name Signature of Owner/Program Administrator Date I attest that our program is following all requirements as stated above: Type or Print Program Coordinator Name Signature of Program Coordinator Date 3

4 Instructor Information Program Date: / / Program Coordinator Information Please indicate if PC also serves as: Clinical Instructor and/or Classroom Instructor Primary Instructor Information 1

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7 NATCEP Clinical Facilities Used Program Date: / / Facility Clinical Facility Information Contractual Agreement Signed by*: Phone Number: ( ) - Clinical Contact Information** Phone Number: ( ) - Facility Clinical Facility Information Contractual Agreement Signed by*: Phone Number: ( ) - Clinical Contact Information** Phone Number: ( ) - *This is the facility representative who signed the clinical contract. **This is the facility employee through which you arrange student clinical time. 1

8 Facility Clinical Facility Information Contractual Agreement Signed by*: Phone Number: ( ) - Clinical Contact Information** Phone Number: ( ) - Facility Clinical Facility Information Contractual Agreement Signed by*: Phone Number: ( ) - Clinical Contact Information** Phone Number: ( ) - *This is the facility representative who signed the clinical contract. **This is the facility employee through which you arrange student clinical time. 2

9 Facility Clinical Facility Information Contractual Agreement Signed by*: Phone Number: ( ) - Clinical Contact Information** Phone Number: ( ) - Facility Clinical Facility Information Contractual Agreement Signed by*: Phone Number: ( ) - Clinical Contact Information** Phone Number: ( ) - *This is the facility representative who signed the clinical contract. **This is the facility employee through which you arrange student clinical time. 3

10 NATCEP Additional Classroom Sites Program Date: / / Site Site Site 1

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