Orientation and In-service Program Requirements

In-service and Orientation programs are required for all Skilled Nursing Facilities (SNF) and Intermediate Care Facilities (ICF). 

​Initial Application:

The following items must be submitted for application consideration:

• Nurse Assistant Orientation Program Content (CDPH 278A) (PDF) (Revised 12/19)
• Submit a lesson plan for a direct patient care skill that is taught during supervised clinical training included in the first 8 hours of the orientation.
• Submit a copy of the orientation skills return demonstration record used to document the basic patient care clinical training from first 8 hours of the orientation.
• In-Service Training Program (CDPH 278B) (PDF) (Revised 12/19)
• Submit two lesson plans from two different topics listed that you listed on your CDPH 278B form.
• Submit a three-month in-service schedule for future months.
• In-service Training for Certified Nurse Assistants Attendance Sign-in Sheet (CDPH 278D) (PDF) (Revised 02/22)
• If your facility uses its own sign-in sheet, submit a copy. It must include the following:
• Name of the health facility
• In-service course title
• Date of in-service
• In-service start time and end time
• Instructor name (typed/printed) and instructor's signature
• Participant's name (typed/printed) and participant's signature 
• Participant's CNA or HHA certification number
• Submit a copy of the record keeping policy.  It must include the following:
  
• Which in-service records are maintained (sign-in sheets, lesson plans, written exam etc.)?
• How long (4-year minimum) are the In-service records maintained?
• Storage location address.
• How records are stored (hard copy or digital)?
• The title of the person responsible for the record keeping.
• Facility Declaration of Participation in Approved Training Programs (CDPH 278C) (PDF) (Revised 01/20) - Required for SNF and ICF only
• If you are choosing Option 2: Nurse Assistant Pre-certification Training Contract on CDPH 278C, then submit CDPH 278SC Sample Contract Template (PDF) (Revised 01/20)
• Director of Staff Development Application (CDPH 279) (PDF) (Revised 11/22)
• Important Update:  There must be a valid resume on file with the Department for all Department approved Director(s) of Staff Development or training program Instructors.
• Contact Information Form (CDPH 193) (PDF) (Revised 12/19)
•  Copy of Department issued facility license.
• If your facility is unable to meet the Orientation requirements listed in 22 CCR §71833(e), submit Temporary Permission for Program Flexibility and for Emergencies (CDPH 5000A) (PDF) (Revised 07/20) to request program flexibility.

Renewal Application:

The following items must be submitted for renewal of SNF and ICF related programs.  Please follow the instructions listed in the Combined Renewal Application for SNF/ICF (CDPH 278R). 

Note:  Your facility may submit an initial Nurse Assistant Training Program (NATP) application with an Orientation and In-service Program update or renewal (CDPH 278R). Please visit the NATP webpage for all items needed for consideration of an initial SNF/ICF NATP application.

• Certified Nurse Assistant Orientation, In-service and Nurse Assistant Training Program Combined Renewal (SNF/ICF) (CDPH 278R) (PDF) (Revised 04/22)
• Director of Staff Development Application (CDPH 279) (PDF) (Revised 11/22)
• Important Update:  There must be a valid resume on file with the Department for all Department approved Director(s) of Staff Development or training program Instructors.
• Note:  Only send this for new DSD applicants. If a DSD is already approved for your facility and TPRU has the approved resume on file, you do not need to resend this form for renewals.

Orientation Program Updates (CDPH 278R Section A):

• Submit a copy of your previously approved CDPH 278A form if the Orientation Program has not changed since the last renewal.
• If changes have occurred to the Orientation Program, submit the following:
• Nurse Assistant Orientation Program Content (CDPH 278A) (PDF) (Revised 12/19)
• Lesson Plan for a Direct Patient Care Skill (CDPH 278A, page 2, #1).
• Skills Return Demonstration Record (CDPH 278A, page 2, #2).
• If your facility is unable to meet the Orientation requirements listed in 22 CCR §71833(e), submit Temporary Permission for Program Flexibility and for Emergencies (CDPH 5000A) (PDF) (Revised 07/20) to request program flexibility.

In-Service Training Program Renewal (CDPH 278R Section B):

• Submit a three-month in-service schedule for future months.
• In-service Training for Certified Nurse Assistants Attendance Sign-in Sheet (CDPH 278D) (PDF) (Revised 02/22)
  
• If your facility uses its own sign-in sheet, submit a copy. It must include the following:
• Name of the health facility
• In-service course title
• Date of in-service
• In-service start time and end time
• Instructor name (typed/printed) and instructor's signature
• Participant's name (typed/printed) and participant's signature 
• Participant's CNA or HHA certification number
• Submit one in-service lesson plan from the Course Titles listed on your three-month in-service schedule.

Declaration of Participation in Approved Training Programs (CDPH 278R Section C):

• Option 1 – Submit NATP initial application or see below for NATP renewal requirements.  
• Option 2 – Submit CDPH 278SC Sample Contract Template (PDF) (Revised 01/20).
• Option 3 – No additional documents needed.

Nurse Assistant Training Program Renewal for SNF/ICF (CDPH 278R Section D):

If your facility conducts its own Nurse Assistant Training Program (NATP), submit the following for renewal with the CDPH 278R:

• Nurse Assistant Certification Training Program Application (CDPH 276F) (PDF) (Revised 04/19)
• Daily Nurse Assistant Training Program Schedule (CDPH 276B) (PDF) (Revised 12/19)
• Submit the following if changes have occurred since your last approval:
• Nurse Assistant Training Program Skills Check List (CDPH 276A) (PDF) (Revised 12/18)
• Nurse Assistant Certification Training Program Individual Student Record (CDPH 276C) (PDF) (Revised 11/18)
• Administrative Policies and Procedures Packet (CDPH 276P) (PDF) (Revised 01/19)
• Four Lesson Plans (if Curriculum changed)
• Organizational Chart of your NATP
• Job Descriptions for program administrator, program director and instructors.
• Instructor Monitoring Tool
• Note:  To be used by RN program director or administrator to monitor the instructor during theory and clinical.
  

How to submit your application:

Email: TPRU@cdph.ca.gov
Fax: 916-636-6760
Do NOT send by mail.
Visit the TPRU Website for more information.