Texas AIT internship manual

STATE OF TEXAS ADMINISTRATOR-IN-TRAINING INTERNSHIP MANUAL
February, 2004
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 AITS PERFORMANCE ....................................................................................................... 30 PRECEPTOR PERFORMANCE REPORT .......................................................................................................... 31 DEPARTMENT HEAD CERTIFICATION .......................................................................................................... 33
Administrator-In-Training Manual 09/01/2004
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Texas Nursing Facility Administrator Program Department of Aging and Disability Services
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 Administrators Advisory Committee and the Department of Aging and Disability Services (formerly known as 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.
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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.
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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 AITs 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 AITs 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.
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AIT Qualifications and Responsibilities The AIT must: be enrolled in an academic institution of higher education, completing courses towards attainment of a bachelors 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 bachelors 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 preceptors 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 w ith th e on -site ad ministrator f or th e AIT i n th e acad emic setti ng. Additional m eetings w ith the academ ic preceptor, who maintains responsibility for the AIT, would be per the schools 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
Administrator-In-Training Manual 09/01/2004 Texas Nursing Facility Administrator Program Department of Aging and Disability Services
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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. DADS 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 administrators 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 preceptors (or administrators) 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.
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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 AITs 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 DADS, verifying the AITs 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 institutions 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 DADS 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 DADS forms and the appropriate fees. Documentation The following documents must be completed during the AITs internship: Administrator-inTraining Self-Assessment Tool; Administrator-In-Training Assignment Agreement; Department Head Certification; Administrator-in-Training Final Report; and Preceptors Performance Report. Upon completion of the internship, the completed forms shall be mailed to DADS Credentialing Department. Copies of these documents are included in the manual.
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Notes
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HELPFUL TOPICS/ISSUES
For the Administrator-In-Training Program
RESIDENT CARE MGMT PERSONNEL MGMT Policies and Procedures Resident Needs Aging Diseases Terminology Referrals Admissions Discharge Transfers Death Medical Records Residents rights Advanced Directives Infection Control Universal Precautions Weight loss protocols Safety and Security Smoking policy Physical Assessment and Schedule MDS forms Care Plans Staffing Dietary Nutrition/snacks Activities Social services Nursing Medical Director Duties Physician visits Standing Orders Restraints Pharmacy Drug Control Contract Services Insurance Utilization- Review/QA Policies and Procedures Role of Administration Leadership Skills Unions Job Descriptions Staffing Recruitment Interview do's and don'ts Hiring policies Labor laws Reference checks Criminal records Emloyment contracts Salary negotiation Benefits program Supervision Orientation On-the-job training Cont. Education/ In-Services Retention Performance Review Timekeeping Absenteeism Corrective Action Sexual Harassment Discrimination Nepotism policy Grievance Employee assistance Morale Motivation FINANCIAL MGMT Policies and Procedures Definition of Terms CFO Comptroller Business office Planning Capital Budget Development Furniture, Fixtures, and Equipment (FF&E) 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 Receivables Payables Purchasing Purchase Order Inventory Vendor Contracts Timekeeping Wages Payroll Garnishment ENVIRONMENTAL MGMT Policies and Procedures Building standards Construction Maintenance Preventive Maintenance Scheduling Maintenance logs Repairs Heating & Air conditioning Elevator maintenance Exterior care 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 Hot water temperatures Reports Smoke-detector & Sprinkler Maintenance Bio-Hazard Materials Isolation Universal Precautions/ Infection Control REGULATORY MGMT Policies and Procedures Administrators role Planning, Organizing, Directing, Controlling, Coordinating Delegation of Duties Legal responsibilities Definition of legal terms Joint Commission (JCAHO) Health Care Finance Admin. Federal, State and City Regulations Licensing Standards Conditions of Participation Surveys and Complaints Informal Dispute Resolution Deficiencies Plan of Correction Compliance Special Care Units 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 Workers Compensation Medicaid Services Medicare Fiscal Itermediary Reimbursement guidelines ORGANIZATIONAL MGMT Policies and procedures Ownership/Governance Conflict of Interest Policy Writing Strategic Planning Goal Setting Plan Implementation Evaluation Mission Statement Philosophy of operations Board/Staff Relations Corporate Relations 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) Lawsuits ETHICS Policies and procedures Mission Statement Admission policies Discharge policies Transfer policies Civil Rights Legal Research End-of-life decisions Advanced Directives POA/ DPOA/ Guardian Living Wills Nutrition and Hydration Withholding or Withdrawing treatments Marketing/Advertising Materials Administrator's Compensation Staff Relations Wage/Salary administration Staff morale Grievance procedures Recruitment Hiring practices Conflict of Interest Contracting Policies Fraud and Abuse
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HELPFUL TOPICS/ISSUES
For the Administrator-In-Training Program
RESIDENT CARE MGMT PERSONNEL MGMT Positive Family involvement Complaint reduction Health status of resident Theft and Abuse Suicide Precautions Fall Prevention program Volunteer Program Hospice Dementia care Behaviour problems Skin Care protocols Documentation Fire Drills/Evacuation Malpractice FINANCIAL MGMT Uniform Cost Report Break-Even Analysis Current Ratio Depreciation schedules Resident Charges Liquidity Net Worth Retained earnings Journal Ledger Reconciliation Trial Balance Tax Forms Investments Dividends Amortization Schedule Balance Sheet ENVIRONMENTAL MGMT MSDS forms OSHA EPA NFPA Fire Drills Fire Control Emergency Equipment Back-up generator REGULATORY MGMT EEOC ADA OBRA COBRA OSHA Section 504 Equal Pay Act 1963 ORGANIZATIONAL MGMT ETHICS
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ADMINISTRATOR-IN-TRAINING
JOB DESCRIPTION Job Title: Department: Administrator-in-Training 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 E ffort: 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.
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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.
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SELF-ASSESSMENT TOOL DATE LICENSE NO.
AIT NAME FACILITY PRECEPTOR NAME
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 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 Degree received Years completed
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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 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 1 2 3 4
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Self-assessment continued 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
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Self-assessment continued 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
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Self-assessment continued 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 A. Staffing requirements 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
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Self-assessment continued 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 A. Staffing requirements 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
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Self-assessment continued 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
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Self-assessment continued 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
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ASSIGNMENT AGREEMENT
AIT NAME PRECEPTOR NAME FACILITY ADDRESS DATE LICENSE NO
PHONE NUMBER STARTING DATE
VENDOR NUMBER COMPLETION DATE
TOTAL NUMBER OF WEEKS TO COMPLETE PROGRAM DEPARTMENT ASSIGNMENT ADMINISTRATION NURSING SERVICE MEDICAL RECORDS DIETARY RESIDENT ACTIVITIES SOCIAL SERVICES ENVIRONMENTAL SERVICES ETHICS OTHER e.g. Corporate Office, Other facilities etc. B EGINNING DATE ASSIGNED HOURS DEPT. HEAD
I hereby agree with, and understand, that I must successfully complete all the above assignments in order to fulfill the DADS 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
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Notes
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FINAL REPORT NAME ADDRESS FACILITY NAME PRECEPTOR NAME LICENSE NO. LICENSE NO. DATE
INSTRUCTIONS: The Preceptor must complete the date and number of hours showing the AIT had time and experience in that area. Based on the AITs Self-Assessment, there will be activities he/she did not need to cover in the rotation. The P receptor 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 Policies and Procedures Resident Needs Aging Diseases Terminology Referrals Admissions Discharge Transfers Death Medical Records Residents 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
Date completed No. of Hours Preceptor Initials
Administrator-In-Training Manua1 09/01/2004
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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 Policies and Procedures Role of Administration Leadership Skills Unions Job Descriptions Staffing Recruitment Interview do's and donts Hiring Labor laws Retention Supervision Sexual Harassment Discrimination Orientation On-the-job training
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Final report continued Mandatory In-Services Performance Review Timekeeping Wages Absenteeism Corrective Action Grievance Employee assistance Morale Motivation FINANCIAL MGMT Policies and Procedures 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
Date Completed
No of Hours
Preceptor initials
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Final Report Continued 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 Policies and Procedures Building standards Construction Maintenance Preventive Maintenance Scheduling Maintenance logs Repairs Heating & Air conditioning Elevator maintenance Exterior care
Date Completed
No of Hours
Preceptor initials
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Final Report continued 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 Policies and Procedures Administrators role Planning, Organizing, Directing, Controlling, Coordinating
Date Completed
No of Hours
Preceptor initials
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Final Report continued 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 Workers Compensation Medicaid Services Medicare Fiscal Intermediary Reimbursement guidelines Equal Pay Act 1963 Section 504 EEOC ADA OBRA COBRA OSHA Local Survey and Regulatory Agencies
Date Completed
No of Hours
Preceptor initials
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Final Report continued

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
Date Completed
No of Hours
Preceptor initials
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Final Report Continued Wage/Salary Administration Staff morale Recruitment Hiring Practices Conflict of Interest Contracting Policies
EVALUATION OF AITS 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. Preceptor Signature Administrator-in-Training Signature
State of Texas County of Before me,
Date Date
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)
Administrator-In-Training Manua1 09/01/2004 Texas Nursing Facility Administrator Program Department of Aging and Disability Services
Page 30 of 45
PRECEPTOR PERFORMANCE REPORT

(To be completed by the Administrator-in-Training at the end of the internship)
Name of Preceptor Facility Name and Address Phone Number Date Internship Began
License No.
Vendor No. Ended
The goal of th is evalu ation is to p rovide f eedback to th e p receptor on the strengths and weaknesses of the internship. It is also to assist the Texas Departm ent of Aging and Disability Services in assur ing adequate training for future AITs. It is im portant that the AIT an swer th e q uestions as ob jectively as p ossible. A copy of the completed Evaluation shall be given to th e Preceptor and the original mailed to the Credentialing Department of the Texas Department of Aging and Disabilit y Se rvices aft er it has be en sw orn and notarized by a public notary. 1. Did the Preceptor conduct an initial interview to review and verify the AIT SelfAssessm ent? 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. w
Was your preceptor actively involved in your training and available for consultation hen necessary?
Page 31 of 45
7. Give a brief analysis of any positive experience or problem encountered during the int ernship.
8. 9.
Overall how would you rate your experiences? Excellent Very Helpful He lpful Would you recommend this preceptor to another AIT? If no, explain Yes
Unsatisfactory
10. Additional
comments
Preceptor Signature Administrator-in-Training Signature

State of Texas County of Before me,
Date Date
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)
Page 32 of 45
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/mangers 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 selfassessment 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 AITs 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.
Page 33 of 45
Notes
Page 34 of 45
ADMINISTRATION A. 1. 2. 3. 4. 5. 6. 7. 8. General Administration and Management Ownership of facility Governing body make-up and duties Administrator's duties & authority How policy is made Policy and procedures manual Value and use of staff meetings How to develop program plans 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
Administrator-In-Training Manual 09/01/2004 Page 35 of 45 Texas Nursing Facility Administrator Program Department of Aging and Disability Services
Date No of Hours Initials
Administration continued 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
Date
No of Hours
Initials
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 Strengths:
hours of training of the above mentioned AIT.
Weaknesses:
Date
Department Head Signature
Page 36 of 45
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. 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. 1. 2. 3. 4. 5. 6. 7. Medications Storage - external, internal, Schedule II Administration Disposal - routine and Schedule II Medication errors Unnecessary drugs Psychotropic drugs PRN orders
G. Resident incident and accident reports H. Handling emergencies - transfer I. Isolation J. Care of deceased K. Counseling resident/family
Page 37 of 45
Nursing Service continued L. Quality assessment committee M. Discharge and transfer N. Evaluating nursing service O. Peer Review
Date
No of Hours
Initials
I hereby certify that I have completed the assigned
hours of training of the above mentioned AIT.
Strengths:
Weaknesses:
Date
Page 38 of 45
Medical Records
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
Administrator in Training Signature I hereby certify that I have completed the assigned Strengths: hours of training of the above mentioned AIT.
Weaknesses:
Date
Page 39 of 45
DIETARY
A. Staffing requirements B. State,County,City health requirements 1. Dress requirements 2. Health cards C. Menus and records 1. Therapeutic diets 2. Retention of records D. 1. 2. 3. Purchasing, receiving, storage Procedures for purchasing Receiving reports Storage and temperatures
E. Issuing from storeroom, security F. 1. 2. 3. 4. Food preparation and serving Dining area - cleaning Food carts, food trays Serving/portions/snacks Temperatures of hot/cold food
G. Dietary equipment -- care and upkeep H. 1. 2. 3. 4. 5. Sanitation Preventing disease spread Handwashing facilities Dishwashing Garbage storage and disposal Pest control
I. Prevention and control of grease fires J. Monitoring and evaluating food service I certify I have undergone training in the above department in accordance with the AIT guidelines.
Weaknesses:
Date
Page 40 of 45
RESIDENT ACTIVITIES
A. Staffing requirements B. 1. 2. 3. 4. C. 1. 2. 3. 4. 5. Planning resident activities Determining capabilities Checking physician orders Scheduling events Coordination with Nursing, Dietary, etc. Carrying out activities Proper techniques with residents Group activities Exercising residents Motivating residents 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 I certify I have undergone training in the above department in accordance with the AIT guidelines.
Weaknesses:
Date
Page 41 of 45
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
Administrator in Training Signature I hereby certify that I have completed the assigned hours of training of the above mentioned AIT.
Strengths:
Weaknesses:
Date
Page 42 of 45
ENVIRONMENTAL SERVICES
A. 1. 2. 3. 4. 5. 6. 7. 8. 9. B. 1. 2. 3. 4. 5. 6. 7. 8.
Housekeeping Staffing & scheduling Cleaning schedules Procedures for cleaning Procedures for odor control Use and care of equipment Safety and security of the housekeeping cart Handling of contaminated materials Wet Floor Signs Furniture placement/exit access Laundry Linen requirement Handling soiled linen Linen storage and control Transporting of linens Laundry procedures Use and care of equipment Water Temperatures 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. 1. 2. 3. 4. E. 1. 2. 3. 4. Fire and disaster Fire prevention and control Disaster plan Inspection and tagging of fire extinguishers Fire Drills Safety and Health OSHA requirements Infection control Employee health Hepatitis B Vaccinations Page 43 of 45 Texas Nursing Facility Administrator Program Department of Aging and Disability Services
Environmental Services continued 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
Date
No of hours
Initials

I hereby certify that I have completed the assigned Strengths: hours of training of the above mentioned AIT.
Weaknesses:
Date
Page 44 of 45
ETHICS
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 I certify I have undergone training in the above department in accordance with the AIT guidelines.
Weaknesses:
Date
Page 45 of 45

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STATE OF TEXAS ADMINISTRATOR-IN-TRAINING INTERNSHIP MANUAL

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

General Guidelines for AIT program

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

SELF-ASSESSMENT TOOL DATE LICENSE NO.

AIT NAME FACILITY PRECEPTOR NAME

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

PHONE NUMBER STARTING DATE

VENDOR NUMBER COMPLETION DATE

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manua1 09/01/2004

Final Report continued

Administrator-In-Training Manua1 09/01/2004

Administrator-In-Training Manua1 09/01/2004

Administrator-In-Training Manua1 09/01/2004

Administrator-In-Training Manua1 09/01/2004

Final Report continued

NARRATIVE: To be completed by the Preceptor

Notary Public, State of Texas

PRECEPTOR PERFORMANCE REPORT

Vendor No. Ended

Did you have adequate input into your AIT Assignments?

How often did you meet with your preceptor?

Administrator-In-Training Manua1 09/01/2004

Preceptor Signature Administrator-in-Training Signature

Notary Public, State of Texas

Administrator-In-Training Manua1 09/01/2004

Administrator-In-Training Manua1 09/01/2004

Administrator-In-Training Manua1 09/01/2004

Administrator in Training Signature

I hereby certify that I have completed the assigned Strengths:

hours of training of the above mentioned AIT.

Department Head Signature

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator in Training Signature

I hereby certify that I have completed the assigned

hours of training of the above mentioned AIT.

Department Head Signature

Administrator-In-Training Manual 09/01/2004

Department Head Signature

Administrator-In-Training Manual 09/01/2004

Department Head Signature

Administrator-In-Training Manual 09/01/2004

Department Head Signature

Administrator-In-Training Manual 09/01/2004

Department Head Signature

Administrator-In-Training Manual 09/01/2004

Administrator-In-Training Manual 09/01/2004

Administrator in Training Signature

Department Head Signature