STATE OF TEXAS ADMINISTRATOR-IN-TRAINING INTERNSHIP MANUAL

Transcription

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 AIT’S PERFORMANCE ....................................................................................................... 30
PRECEPTOR PERFORMANCE REPORT .......................................................................................................... 31
DEPARTMENT HEAD CERTIFICATION .......................................................................................................... 33
Administrator-In-Training Manual
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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 Administrator’s 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:
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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 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:
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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.
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AIT Qualifications and Responsibilities
The AIT must:
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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 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 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
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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
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.
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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 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 DADS, 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 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 AIT’s internship: Administrator-inTraining 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 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
FINANCIAL MGMT
ENVIRONMENTAL MGMT
REGULATORY MGMT
ORGANIZATIONAL MGMT
ETHICS
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
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
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
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
Administrator’s 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
Worker’s Compensation
Medicaid Services
Medicare
Fiscal Itermediary
Reimbursement guidelines
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
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
Contracting Policies
Fraud and Abuse
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
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HELPFUL TOPICS/ISSUES
For the Administrator-In-Training Program
RESIDENT CARE MGMT PERSONNEL MGMT
FINANCIAL MGMT
ENVIRONMENTAL MGMT
REGULATORY MGMT
Positive Family
involvement
Complaint reduction
Uniform Cost Report
MSDS forms
EEOC
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
ORGANIZATIONAL MGMT
ETHICS
Dividends
Amortization Schedule
Balance Sheet
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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 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
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
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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
1
2
3
4
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
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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
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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
1
2
3
4
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
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B. The medical record
1. Contents
2. Sequence in filing
3. Charting errors – corrections
4. Thinning charts
1
2
3
4
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
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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2. Hand-washing facilities
3. Dishwashing
4. Garbage storage and disposal
5. Pest control
1
2
3
4
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
09/01/2004
Page 18 of 45
F. Handling residents' personal needs
1
2
3
4
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
09/01/2004
Page 19 of 45
6. Workplace violence
7. Safety
8. Smoking policies
9. Safe Medical Devices Act
10. Lockout Tag-out
1
2
3
4
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
09/01/2004
Page 20 of 45
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
B
EGINNING
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 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
09/01/2004
Page 21 of 45
Notes
09/01/2004
Page 22 of 45
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 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
Date
completed
No. of Hours
Preceptor
Initials
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
Administrator-In-Training Manua1
09/01/2004
Page 23 of 45
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
09/01/2004
Page 24 of 45
Final report continued
Date
Completed
No of Hours
Preceptor
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
09/01/2004
Page 25 of 45
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
09/01/2004
Page 26 of 45
Date
Completed
No of Hours
Preceptor
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
09/01/2004
Page 27 of 45
Date
Completed
No of Hours
Preceptor
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
09/01/2004
Page 28 of 45
ORGANIZATIONAL MGMT
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)
Date
Completed
No of Hours
Preceptor
initials
ETHICS
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
09/01/2004
Page 29 of 45
Final Report Continued
Wage/Salary
Administration
Staff morale
Recruitment Hiring Practices
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.
Preceptor Signature
Date
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)
09/01/2004
Page 30 of 45
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 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?
09/01/2004
Page 31 of 45
7.
Give a brief analysis of any positive experience or problem encountered during the
int
ernship.
8.
Overall how would you rate your experiences?
Excellent
Very Helpful
He
lpful
9.
Would you recommend this preceptor to another AIT?
If no, explain
10. Additional
Unsatisfactory
Yes
comments
Preceptor Signature
Date
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)
09/01/2004
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/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 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 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.
09/01/2004
Page 33 of 45
Notes
09/01/2004
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
Date
No of Hours
Initials
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
09/01/2004
Page 35 of 45
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
Date
No of Hours
Initials
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
09/01/2004
Department Head Signature
Page 36 of 45
NURSING SERVICE
Date
1. RN's, LVN's, CNA's
2. Scheduling
3. Medical director
No of Hours
Initials
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
09/01/2004
Page 37 of 45
Nursing Service continued
Date
No of Hours
Initials
L. Quality assessment committee
M. Discharge and transfer
N. Evaluating nursing service
O. Peer Review
Strengths:
Weaknesses:
Date
09/01/2004
Page 38 of 45
Medical Records
Date
No of Hours
Initials
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
2. Confidentiality
3. Release of information
F. Closing a medical record
G. Evaluating the medical records program
Strengths:
Weaknesses:
Date
09/01/2004
Page 39 of 45
DIETARY
Date
No of Hours
Initials
B. State,County,City health requirements
1. Dress requirements
2. Health cards
C. Menus and records
1. Therapeutic diets
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
Strengths:
Weaknesses:
Date
09/01/2004
Page 40 of 45
RESIDENT ACTIVITIES
Date
No of Hours
Initials
B.
1.
2.
3.
4.
Planning resident activities
Determining capabilities
Checking physician orders
Scheduling events
Coordination with Nursing, Dietary, etc.
C.
1.
2.
3.
4.
5.
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
Strengths:
Weaknesses:
Date
09/01/2004
Page 41 of 45
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:
Date
09/01/2004
Page 42 of 45
ENVIRONMENTAL SERVICES
Date
A.
1.
2.
3.
4.
5.
6.
7.
8.
9.
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
B.
1.
2.
3.
4.
5.
6.
7.
8.
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
No of Hours
Initials
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.
Fire and disaster
Fire prevention and control
Disaster plan
Inspection and tagging of fire extinguishers
Fire Drills
E.
1.
2.
3.
4.
Safety and Health
OSHA requirements
Infection control
Employee health
Hepatitis B Vaccinations
09/01/2004
Page 43 of 45
Date
Environmental Services continued
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:
Date
09/01/2004
Page 44 of 45
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:
Date
09/01/2004
Page 45 of 45

STATE OF TEXAS ADMINISTRATOR-IN-TRAINING INTERNSHIP MANUAL

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