The purpose of this amendment is to clarify the requirements of the Administrator-in-Training goal oriented training plan and to incorporate by reference the Florida AIT Domains of Practice Quarterly Checklist form, DH-MQA 1209 (revised 06/09).

DEPARTMENT OF HEALTH
Board of Nursing Home Administrators

RULE NO: RULE TITLE
64B10-16.005: Domains of Practice, Objectives, Reports
PURPOSE AND EFFECT: The purpose of this amendment is to clarify the requirements of the Administrator-in-Training goal oriented training plan and to incorporate by reference the Florida AIT Domains of Practice Quarterly Checklist form, DH-MQA 1209 (revised 06/09).
SUMMARY: The amendment clarifies the requirements of the Administrator-in-Training goal oriented training plan and incorporates by reference Florida AIT Domains of Practice Quarterly Checklist form.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 468.1685(1), 468.1695(3), (4) FS.
LAW IMPLEMENTED: 468.1695(3), (4) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Joe Baker, Jr., Executive Director, Board of Nursing Home Administrators, 4052 Bald Cypress Way, Bin #C07, Tallahassee, Florida 32399-3257

THE FULL TEXT OF THE PROPOSED RULE IS:

64B10-16.005 Domains of Practice, Objectives, Reports.

(1) A training plan for the Administrator-in-Training Program shall be prepared by the preceptor and the trainee, prior to the start of the program. This training plan shall include:

(a) A pre-training assessment of the trainee’s background in terms of educational level, pertinent experience, maturity, motivation and initiative. The pre-training assessment should underscore the particular trainee’s strengths and weaknesses in the areas to be covered in the program (e.g. a person with a degree in business administration will have strengths in the finance area; a person with a personnel or management background will have strengths in those areas, etc.).

(b) Based on this assessment, the trainee and the preceptor will jointly develop a detailed goal oriented training plan with adequate supporting documentation which relates educational objectives, subject areas of the internship, internship site(s), agencies involved, total hours for the internship, and a breakdown of the number of hours needed to master each area and its objectives.

(c) Supporting documentation for the training plan shall include, but is not limited to, qualifications of the preceptor, the director of nursing in the program site, and such descriptive documentation for the program site and its staff to determine its adequacy for the specific objectives and areas of the program.

(d) The preceptor and administrator in training must file reports with the Board every 90 days. The report shall be made on the State of Florida AIT Domains of Practice Quarterly Checklist, Form DH-MQA 1209 (revised 06/09, hereby adopted and incorporated by reference) which can be obtained from the Board of Nursing Home Administrators’ website at: http://www.doh.state.fl.us/mqa/nurshome/index.html. Each report shall be co-signed by the preceptor and administrator in training and shall be filed within two weeks after the completion of each reporting period of the program. The reports shall contain a synopsis of the areas covered in the program and a narrative describing relevant learning experiences. The reports shall show how the administrator in training used the following methods to further his or her training:

1. On-the-job experience;

2. Meetings attended;

3. Surveys completed;

4. Written reports;

5. Texts or periodicals;

6. Visits to other facilities;

7. Academic programs, college or continuing education seminars.

(2) The Administrator-in-Training Program shall cover the following domains of practice:

(a)(1) PERSONNEL. Topics in this area should include recruitment, interviewing, employee selection, training, personnel policies, health and safety. Objectives of training are:

1.(a) To understand the need and procedures used in training personnel, including interviewing for vacant positions;

2.(b) To become familiar with proper human relations regarding management, employees, patients and families;

3.(c) To understand the organizational structure of the facility, the functions of each department, and the personnel relations within the facility.

4.(d) To display the ability to instruct staff on conducting appraisals.

5.(e) To demonstrate the knowledge of and use of appropriate supervisory techniques.

(b)(2) FINANCE. Topics in this area should include accounting, budgeting, financial planning and asset management. Objectives of training are:

1.(a) To understand accounting procedures, chart of accounts, profit and loss statements, balance sheets, cost reports, accounts receivable, and policies relative to accounts payable and collection of accounts receivable;

2.(b) To understand the preparation of budgets;

3.(c) To be familiar with cash flow preparations and needs;

4.(d) To be familiar with third party payment organizations.

5.(e) To possess the ability to prepare a business plan, a feasibility study, and a return on investment (ROI) proposal.

6.(f) To understand how to develop, plan and manage an interdisciplinary budget.

(c)(3) MARKETING. Topics in this area should include public relations activities and marketing programs. Objectives of training are:

1.(a) To present to the public the essential medical relations and benefits of the facility to the welfare of the local community, the local health agencies, and other organizations such as church groups, social clubs, and service organizations;

2.(b) To know and be able to utilize community volunteer agencies’ resources in the care of residents;

3.(c) To be able to relate to a variety of community resources, such as churches, professional organizations and institutional structures that affect the facility.

(d)(4) PHYSICAL RESOURCE MANAGEMENT. Topics in this area should include safety procedures, fire and disaster plans, and building and environment maintenance. Objectives of training are:

1.(a) To develop an effective supply appreciation and supervisory knowledge and ability to keep all medical equipment and appliances necessary, available, and in good working order;

2.(b) To have full knowledge of sanitation, communicable disease control, prevention of accidents and complete physical security for staff and patients, coordinating this information by application to safety codes and fire prevention;

3.(c) To understand routine maintenance needs and procedures for buildings, surrounding grounds, vehicles and other equipment.

4.(d) To use the concepts of disaster preparedness, and to demonstrate an understanding of the facility’s roles and vulnerabilities (including how to conduct an evacuation).

(e)(5) LAWS, REGULATORY CODES AND GOVERNING BOARDS. Topics in this area should include federal, state and local rules and regulations. Objectives of training are:

1.(a) To learn how to apply the state’s codes, rules, regulations, and laws relating to long-term care facilities;

2.(b) To integrate current federal regulations pertaining to health care facilities with current state requirements;

3.(c) To become familiar with requirements of medicare and medicaid, and to learn to cope with their problems;

4.(d) To understand the basic insurance coverages;

5.(e) To have a sense of the legal implications of various activities, procedures or decisions routinely taken or performed in the facility.

(f)(6) RESIDENT CARE. Topics in this area should include nursing, food, social and recreational services, pharmacy, rehabilitation, physician services and medical records. Objectives of training are:

1.(a) To understand the roles of the medical director, the attending physicians, the director of nursing, the charge nurse, the physical therapist, occupational therapist, speech therapist, dietitians, pharmacist, licensed practical nurses and aides who provide the continuing essential medical care and rehabilitation of the patients in the facility;

2.(b) To enable the trainee to develop an ability to understand the various components of personal, social, therapeutic and supportive care programs and their application in the total care program of the resident;

3.(c) To develop the ability to function as a planner of the social, therapeutic, and supportive care program;

4.(d) To study the emotional problems of aging in the lives of patients within the facility and to determine the role of the administrator in alleviating such characteristic feelings as loss, abandonment, dependency, depression, anxiety, or disengagement;

5.(e) To determine the role of the administrator in relating to the patient, and the family, who is faced with death;

6.(f) To determine the relationship between changes in a patient’s behavior and changes in his or her environmental, intrapsychic, and/or physical state;

7.(g) To possess the ability to access and interpret facility quality indicators and quality measures;

8.(h) To understand the concepts of benchmaking;

9.(i) To be able to assess facility performance using self-assessment tools.

(3)(7) In order to afford flexibility, and to account for a particular trainee’s strengths or weaknesses in any particular area, the following minimum percentages in every area are established.

(a) PERSONNEL. A minimum of 15% of the program should be devoted to this area.

(b) FINANCE. A minimum of 15% of the program should be devoted to this area.

(c) MARKETING. A minimum of 5% of the program should be devoted to this area.

(d) PHYSICAL RESOURCE MANAGEMENT. A minimum of 10% of the program should be devoted to this area.

(e) LAWS, REGULATORY CODES AND GOVERNING BOARDS. A minimum of 10% of the program should be devoted to this area.

(f) RESIDENT CARE. A minimum of 20% of the program should be devoted to this area.

(8) A training plan for the program shall be prepared by the preceptor and the trainee, prior to the start of the program. This training plan shall include:

(a) A pre-training assessment of the trainee’s background in terms of educational level, pertinent experience, maturity, motivation and initiative. The pre-training assessment should underscore the particular trainee’s strengths and weaknesses in the areas to be covered in the program (e.g. a person with a degree in business administration will have strengths in the finance area; a person with a personnel or management background will have strengths in those areas, etc.).

(b) Based on this assessment, the trainee and the preceptor will jointly develop a detailed goal oriented training plan with adequate supporting documentation which relates educational objectives, subject areas of the internship, internship site(s), agencies involved, total hours for the internship, and a breakdown of the number of hours needed to master each area and its objectives.

(c) Supporting documentation for the training plan shall include, but is not limited to, qualifications of the preceptor, the director of nursing in the program site, and such descriptive documentation for the program site and its staff to determine its adequacy for the specific objectives and areas of the program.

(d) The preceptor and administrator in training must file reports with the Board every 90 days. Each report shall be co-signed by the preceptor and administrator in training and shall be filed within two weeks after the completion of each reporting period of the program. The reports shall contain a synopsis of the areas covered in the program and any relevant learning experiences. The reports shall show how the administrator in training used the following methods to further his or her training:

1. On-the-job experience;

2. Meetings attended;

3. Surveys completed;

4. Written reports;

5. Texts or periodicals;

6. Visits to other facilities;

7. Academic programs, college or continuing education seminars.

(4)(9) Nothing in this rule is intended to preclude any preceptor from requiring any additional areas in the program, objectives, or reports.

Rulemaking Specific Authority 468.1685(1), 468.1695(3), (4) FS. Law Implemented 468.1695(3), (4) FS. History–New 12-18-88, Formerly 21Z-16.005, 61G12-16.005, 59T-16.005, Amended 1-8-06,_______.

NAME OF PERSON ORIGINATING PROPOSED RULE: Board of Nursing Home Administrators
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Nursing Home Administrators
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 19, 2009
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: March 27, 2009