1.0 Definitions
"Activities of Daily Living (ADLs)" means normal daily activities including but not limited to ambulating, transferring, range of motion, grooming, bathing, dressing, eating and toileting.
"Advanced Practice Nurse" means an individual whose education and licensure meet the criteria outlined in 24 Del.C. Ch. 19.
"Certified Nursing Assistant (CNA)" means a duly certified individual under the supervision of a nurse, who provides care which does not require the judgment and skills of a nurse.
"Chemical Restraint" means psychopharmacologic drugs that are used for discipline or convenience and not required to treat medical symptoms.
"Department" means the Department of Health and Social Services.
"Direct Supervision" means actually observing students performing tasks.
“Facility" means a Nursing Facility, Assisted Living Facility or Intermediate Care Facility for Persons with Intellectual Disabilities licensed pursuant to 16 Del.C. Ch. 11.
"Full-Time" means working a minimum of 35 clock hours per week.
"General Supervision" means providing necessary guidance for the program and maintaining ultimate responsibility.
"Nurse" means a licensed practical nurse (LPN), registered nurse (RN) and/or advanced practice nurse (APRN) whose education and licensure meet the criteria in 24 Del.C. Ch. 19.
"Nursing Related Services" means services that include but are not limited to the following: bathing, dressing, grooming, toileting, ambulating, transferring and feeding, observing and reporting the general well-being of the person(s) to whom a qualified person is providing care.
"Physical Restraint" means any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's/patient's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body.
"Resident/Patient" means a person residing in a facility licensed pursuant to 16 Del.C. Ch. 11 or a person receiving care in a licensed acute or outpatient healthcare setting.
"Student" means a person enrolled in a course offering certification as a CNA.
26 DE Reg. 107 (08/01/22)
2.0 Requirements and Procedures for CNA Certification
2.1 Initial certification
2.1.1 To be eligible to take the examination for certification for CNA, the applicant must be a graduate of a Department approved program for CNA.
2.1.2 A certificate of completion must be issued from the approved program before filing an application for testing.
2.1.2.1 The certificate of completion must be dated within 24 months of the testing date.
2.1.2.2 Certificates of completion older than 24 months are no longer valid.
2.1.3 An application for testing shall be filed, along with a non-refundable fee, with the test vendor approved by the Department.
2.1.4 Students must take and pass both the written and clinical portions of the competency test to become certified.
2.1.5 Students who fail to obtain a passing score may repeat the test two additional times.
2.1.5.1 Students who fail to obtain a passing score after testing three times must repeat the CNA training program before retaking the test.
2.1.6 Nursing students who are currently enrolled in a nursing program will be deemed to meet the CNA educational requirements provided they have:
2.1.6.1 Satisfactorily completed a Fundamentals/Basic Nursing course and
2.1.6.2 Satisfactorily completed a specific number of hours of supervised clinical practicum in either a facility or a hospital licensed pursuant to 16 Del.C. Ch. 10 setting, under the direct supervision of a nurse. The total clock hours of clinical training required for certification shall be determined by the Department through written order signed by the Secretary. At no time may the number of clock hours be less than those required by the Centers for Medicare and Medicaid Services.
2.1.6.3 Nursing students will be approved to take the CNA competency test upon submission of a letter from their school of nursing attesting to current enrollment status and a transcript showing satisfactory course completion as described.
2.1.7 Individuals who have graduated from an RN or LPN program in the United States:
2.1.7.1 Within 24 months prior to application for certification are deemed qualified to meet the Department's nurse aide training and competency evaluation program requirements and are eligible for certification upon submission of a sealed copy of their diploma.
2.1.7.2 More than 24 months prior to application for certification are deemed qualified to meet the Department's nurse aide training program requirements and are eligible to take the competency test upon submission of a sealed copy of their diploma.
2.1.8 Foreign trained nurses are eligible to sit for the state competency test if they meet the following requirements:
2.1.8.1 The nurse must have been issued a certificate of licensure by the licensing agency in the state, territory or country where the nursing program is located.
2.1.8.2 The nurse must submit a certificate issued by the Commission on Graduates of Foreign Nursing Schools or other Board of Nursing approved agency as evidence of the educational requirements of a curriculum for the preparation of professional nurses which is equivalent to the approved professional schools in Delaware.
2.1.8.3 The nurse must submit official English translations of all required credentials.
2.1.9 CNA certification shall be granted, for a period of 2 years (24 months) to all CNAs who meet the requirements.
2.2 Reciprocity
2.2.1 Delaware CNA certification is required prior to being employed as a CNA in the State.
2.2.2 A CNA trained and certified in a State other than Delaware must have completed a program that equals or exceeds the federal nurse aide training program requirements in the Code of Federal Regulations §483.152.
2.2.3 The Department will grant reciprocity to the out-of-state applicant provided the CNA:
2.2.3.1 Has a current CNA certificate from the jurisdiction where he or she currently practices.
2.2.3.1.1 Applicants from the State of Maryland must hold a current Geriatric Nursing Assistant certificate.
2.2.3.2 Within the last 24 months, has completed 3 months of full-time experience, equal to 420 clock hours, as a CNA performing nursing related services for pay under the supervision of a nurse or physician, or has completed a training and competency evaluation program with the number of hours at least equal to that required by the State of Delaware.
2.2.3.3 Is in good standing in the jurisdiction where he/she is currently certified.
2.2.3.4 Has submitted the required reciprocity fee along with the application.
2.2.4 CNA certification shall be granted, for a period of 2 years (24 months) to all CNAs who meet the requirements.
2.3 Certification Renewal
2.3.1 CNA certification shall be effective for 2 years following the date of issue and shall expire 2 years following such date, unless it is suspended, revoked, or surrendered prior to the expiration date.
2.3.2 CNAs must apply for certification renewal at least 30 days prior to the expiration date of the certification.
2.3.2.1 The required renewal fee must accompany the application for renewal.
2.3.2.2 The CNA must be able to prove that he/she has completed the requirements outlined in subsection 2.3.4.
2.3.3 A certification renewal will not be issued to a CNA who has not completed the requirements for renewal as outlined in subsection 2.3.4 and/or has not submitted an application for renewal and/or has not submitted the renewal fee.
2.3.4 In order to qualify for recertification, a CNA must complete the following during each 24 month certification period and prior to certification expiration:
2.3.4.1 24 hours of Department approved continuing education which must include:
2.3.4.1.1 Six (6) hours of dementia training and
2.3.4.1.2 Two (2) hours of resident/patient abuse/neglect/mistreatment prevention training.
2.3.4.2 Perform at least 64 hours of nursing related services for pay under the supervision of a nurse.
2.3.5 A CNA who fails to complete the requirements outlined in subsection 2.3.4 must take and pass the competency test again.
2.3.5.1 Payment of the testing fee is required when applying to take the competency test.
2.3.6 A CNA who fails to renew the certification prior to the expiration date but has completed the requirements outlined in subsection 2.3.4 may still renew the certification up to 30 days past the certification's expiration.
2.3.6.1 A late payment fee of $25.00 (in addition to the renewal fee) must be submitted with the renewal application.
2.3.7 The certification of any CNA who is on active military duty with the armed forces of the United States and serving in a theater of hostilities on the date that recertification is due shall be deemed to be current and in full compliance with this chapter until the expiration of 30 days after such CNA is no longer on active military duty in a theater of hostilities.
2.3.8 The certification of a CNA who fails to renew on time or during the 30-day late renewal period is considered lapsed.
2.3.8.1 A CNA with a lapsed certification is not permitted to work as a CNA in the State of Delaware.
2.3.8.2 The CNA must take and pass the CNA competency test in order to work as a CNA in the State of Delaware.
2.3.9 Individuals who fail to obtain a passing score on the written and/or clinical portions of the competency test after testing three times must repeat the CNA training program before additional testing will be permitted.
2.3.10 A CNA, who is certified in Delaware, may not use the certification from another State for the purpose of applying for reciprocity to avoid Delaware's continuing education requirements.
26 DE Reg. 107 (08/01/22)
3.0 CNA Training Program Requirements
3.1 Program approval must be obtained from the Department prior to operating a CNA program.
3.2 All training must be done by or under the general supervision of an RN.
3.2.1 The RN must possess a minimum of two years of RN experience, at least 1 year of which must be in the provision of nursing home facility services that meets federal skilled nursing home requirements.
3.2.1.1 The required one year of full-time nursing facility experience can be met by work experience in, or supervision or teaching of students, in a Delaware licensed nursing facility.
3.2.1.2 The RN supervisor shall:
3.2.1.2.1 Be available to all instructors;
3.2.1.2.2 Assist in developing lesson plans based on experience in taking care of nursing facility residents;
3.2.1.2.3 Ensure that instructors are qualified and proficient in teaching the CNA curriculum;
3.2.1.2.4 Evaluate and document the proficiency of instructor every 6 months; and
3.2.1.2.5 Ensure that the program is operating in accordance with all state and federal regulations.
3.3 All instructors (classroom and clinical) must have:
3.3.1 Completed a Department approved course in teaching adults; or
3.3.2 Experience teaching adults in a group classroom/clinical setting; or
3.3.3 In the case of high school programs, met the requirements for teaching as required by the Department of Education.
3.4 LPN instructors can assist the supervising RN instructors in laboratory skills, but are otherwise limited to instruction of students during the clinical phase of the CNA training program.
3.4.1 LPN instructors must have at least three years of LPN experience; and
3.4.2 LPN instructors must work under the general supervision of an RN.
3.5 Clinical instructors shall provide general supervision of students at all times during clinical instruction.
3.5.1 Clinical instructors shall provide direct supervision to students in the clinical setting while the student is learning a competency until proficiency has been both demonstrated and documented.
3.6 Personnel from other health professions may assist the nurse instructor as supplemental personnel.
3.6.1 Supplemental personnel must have at least 1 year of experience in their respective fields.
3.6.2 Supplemental personnel may include: RNs, LPNs, pharmacists, dieticians, social workers, sanitarians, fire safety experts, nursing home administrators, gerontologists, psychologists, physical and occupational therapists, activity specialist, speech/language/hearing therapists, resident/patient rights experts and others.
3.7 Programs must notify the Department in writing at least 30 days prior to implementing permanent and/or substantial changes to the program or the program's personnel.
3.7.1 Substantial changes include, but are not limited to: instructor(s), clinical or classroom site, major revision of course structure, change in textbook.
3.7.2 The program may request a waiver of the 30-day time period for good cause.
3.8 Classroom ratios of student to instructor shall not exceed 24:1.
3.9 Clinical and laboratory ratios of student to RN or LPN instructor shall not exceed 8:1.
3.10 Minimum equipment required:
3.10.1 Audio/Visual
3.10.2 Teaching Mannequin, Adult, for catheter and perineal care
3.10.3 Hospital Bed
3.10.4 Bedpan/Urinal
3.10.5 Bedside commode
3.10.6 Wheelchair
3.10.7 Scale
3.10.8 Overbed Table
3.10.9 Sphygmomanometer
3.10.10 Stethoscope
3.10.11 Resident/patient gowns, linens and at least four (4) pillows
3.10.12 Thermometers
3.10.13 Crutches
3.10.14 Canes (Variety)
3.10.15 Walker
3.10.16 Gait Belt
3.10.17 Miscellaneous supplies: i.e., bandages, compresses, heating pad, hearing aid, dentures, toothbrushes, razors, bath and emesis basins and compression stockings.
3.10.18 Foley Catheter and Drainage Bag
3.10.19 Mechanical lift
3.10.20 Adaptive eating utensils/equipment
3.10.21 Personal protective equipment
3.11 Curriculum Content and Competencies
3.11.1 The curriculum content for the CNA training programs shall meet each of the following requirements:
3.11.1.1 The material will provide a basic level of both knowledge and demonstrable skills for each individual completing the program.
3.11.1.2 The total, minimum clock hours of classroom instruction and clinical training required for certification shall be determined by the Department through written order signed by the Department Secretary. At no time may the number of clock hours be less than those required by the Centers for Medicare and Medicaid Services.
3.11.1.2.1 Additional hours may be added by the training program in either or both of the classroom instruction or clinical training components.
3.11.2 Specific curriculum content and expected competencies are outlined in APPENDIX A.
3.12 Students must master each skill competency as observed by the RN instructor prior to performing the skill on a resident/patient in a nursing facility. All demonstrable competencies for each student must be documented by the RN instructor as the competency is mastered by the student in order for a student to qualify as successfully having completed that section of programming.
3.13 A student may not work in a facility as a CNA until he/she has completed a CNA training program and passed the CNA competency test.
3.14 Immunizations requirements
3.14.1 The provisions of the State of Delaware, Department of Education, 14 DE Admin. Code 804, are hereby adopted as the regulatory requirements for CNA Training programs in Delaware and are hereby referred to, and made part of this regulation, as if full set out herein.
3.14.2 The provisions of the State of Delaware, Department of Health and Social Services, Division of Public Health, 16 DE Admin. Code 4202 are hereby adopted as the regulatory requirements for CNA Training programs in Delaware and are hereby referred to, and made part of this regulation, as if fully set out herein.
3.14.3 Students that do not meet the minimum vaccination requirements shall not be permitted to participate in clinical training.
3.15 Minimum requirements for tuberculosis (TB) testing of clinical instructors and students are those currently recommended by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services:
3.15.1 A baseline testing must be completed before providing clinical services and, thereafter, as determined by a TB risk assessment.
3.15.2 No person found to have active TB in an infectious stage shall be permitted to participate in clinical training.
3.15.3 Any person having a positive skin test, but a negative chest X-ray must complete a statement annually attesting that they have experienced no symptoms which may indicate active TB infection.
26 DE Reg. 107 (08/01/22)
4.0 Mandatory Orientation Period
4.1 Nursing Facilities General Requirements
4.1.1 All CNAs hired to work in a facility shall undergo a minimum number of clock hours of orientation. The requirements for certified nursing assistant orientation shall be specified by the Department in a written order signed by the Secretary.
4.1.2 Any CNA undergoing orientation may be considered a facility employee for purposes of satisfying the minimum facility staffing requirements. Orientation may also be considered as part of the 64 hour work requirement for certification renewal.
4.1.3 If a CNA who is not employed, or does not have an offer to be employed as a CNA, becomes employed by, or receives an offer of employment from a federally certified nursing facility not later than 12 months after completing a nurse aide training and competency evaluation program, the federally certified nursing facility shall reimburse all documented personally incurred costs in completing the CNA Training program.
4.1.3.1 Facilities shall accept as documentation: canceled checks, paid receipts, written verification from a training program or other written evidence which reasonably establishes the CNA's personally incurred costs.
4.1.3.2 Such costs include tuition, tests taken and fees for textbooks or other required course materials.
4.1.3.3 Such costs shall be reimbursed in equal quarterly payments with full reimbursement to coincide with the CNA's completion of one year of employment including the orientation period.
4.1.3.4 Any nursing facility which reimburses a CNA for documented personally incurred costs of a nurse aide training and competency evaluation program shall notify the Department of such reimbursement.
4.1.3.5 Notice of such reimbursement shall be entered in the CNA Registry database and information regarding such reimbursement shall be available to facilities upon request.
4.2 Orientation Program Requirements
4.2.1 The mandatory orientation program shall be under the supervision of a nurse and must include:
4.2.1.1 Tour of the facility and assigned residents' rooms
4.2.1.2 Fire and disaster plans
4.2.1.3 Emergency equipment and supplies
4.2.1.4 Communication (including the facility chain of command) and documentation requirements
4.2.1.5 Process for reporting emergencies, change of condition and shift report
4.2.1.6 Operation of facility equipment and supplies, including scales, lifts, special beds and tubs
4.2.1.7 Review of the plan of care for each assigned resident/patient including:
4.2.1.7.1 ADL/personal care needs
4.2.1.7.2 Nutrition, hydration and feeding techniques and time schedules
4.2.1.7.3 Bowel and bladder training programs
4.2.1.7.4 Infection control procedures
4.2.1.7.5 Safety needs
4.2.1.8 Role and function of the CNA
4.2.1.9 Resident/patient rights; abuse reporting
4.2.1.10 Safety and body mechanics; transfer techniques
4.2.1.11 Vital signs
4.2.1.12 Psychosocial needs
4.2.1.13 Facility policies and procedures
4.3 Temporary Agency Requirements
4.3.1 All CNAs employed by temporary agencies and placed in a facility in which they have not worked within the previous 6 months shall undergo a minimum of 2 hours of orientation prior to beginning their first shift at the facility.
4.3.2 Any CNA employed by a temporary agency and undergoing orientation shall not be considered a facility employee for purposes of satisfying the minimum facility staffing requirements.
4.3.3 The mandatory two-hour orientation program shall be under the supervision of a nurse and must include:
4.3.3.1 Tour of the facility and assigned resident/patient rooms
4.3.3.2 Fire and disaster plans
4.3.3.3 Emergency equipment and supplies
4.3.3.4 Communication and documentation requirements
4.3.3.5 Process for reporting emergencies, change of condition and shift report
4.3.3.6 Operation of facility equipment and supplies including but not limited to scales, lifts, special beds and tubs
4.3.3.7 Review of the plan of care for each assigned resident/patient including:
4.3.3.7.1 ADL/personal care needs
4.3.3.7.2 Nutrition, hydration and feeding techniques and time schedules
4.3.3.7.3 Bowel and bladder training programs
4.3.3.7.4 Infection control procedures
4.3.3.7.5 Safety needs
26 DE Reg. 107 (08/01/22)
5.0 Discipline
5.1 Reasons for Disciplinary Action Include but are not limited to:
5.1.1 A conviction or substantiation of a crime or offense relating to the provision of care/services in a court of law.
5.1.2 Behavior that fails to conform to legal and accepted healthcare standards and thus may adversely affect the health and welfare of a resident/patient.
5.1.3 Performing acts beyond the authorized scope of the CNA.
5.1.4 Inaccurately and willfully recording, falsifying, or altering a resident/patient or agency/facility record related to care provision.
5.1.5 Abuse, neglect, mistreatment or financial exploitation of a resident/patient.
5.1.6 Leaving a resident/patient assignment except in documented emergency situations.
5.1.7 Failing to safeguard resident/patient dignity and right to privacy when providing services.
5.1.8 Violating the confidentiality of information concerning residents/patients.
5.1.9 Performing CNA duties when unfit to perform procedures and make decisions because of physical or mental impairment or dependence on alcohol or drugs.
5.1.10 Practicing as a CNA with an expired certification.
5.1.11 Allowing another person to use her/his CNA certification or impersonating another person holding a certificate,
5.1.12 Committing fraud, misrepresentation or deceit in taking the CNA test or in obtaining certification.
5.1.13 Failing to comply with the requirements for mandatory continuing education.
5.1.14 Failing to take appropriate action or follow policies and procedures designed to safeguard the resident/patient.
5.1.15 Having a certificate revoked or suspended in another state for reasons which would preclude certification in this state.
5.1.16 Failing to report abuse, neglect, mistreatment or financial exploitation of a resident/patient.
5.2 Types of Disciplinary Action
5.2.1 Refusal to issue a certification.
5.2.2 Revocation or suspension of a certification.
5.2.3 Issuance of a letter of reprimand.
5.2.4 Refusal to renew a certification.
5.2.5 Placement on the Adult Abuse Registry.
5.2.6 Flag on the CNA Registry.
5.3 Administrative Hearings
5.3.1 All hearings shall be conducted in accordance with the Administrative Procedures Act, 29 Del.C. Ch. 101.
5.3.2 A CNA for whom disciplinary action is recommended shall be notified by certified mail at his/her home address of the disciplinary action that shall be imposed.
5.3.3 A CNA for whom disciplinary action is recommended shall be offered a right to an administrative hearing.
5.3.4 All requests for an administrative hearing must be received in writing, postmarked within 20 calendar days of the date of the notice of disciplinary action.
5.3.5 Failure to request an administrative hearing within the appropriate timeframe will lead to imposition of the disciplinary action.
5.3.6 Procedural rights. The parties shall be given the opportunity to:
5.3.6.1 Examine, at a reasonable time before the date of the hearing and during the hearing, all documents and records to be used by either party at the hearing;
5.3.6.2 Bring witnesses;
5.3.6.3 Establish all pertinent facts and circumstances;
5.3.6.4 Present an argument without undue interference;
5.3.6.5 Question or refute any testimony or evidence, including the opportunity to confront and cross-examine adverse witnesses; and
5.3.6.6 Be represented by an attorney of the individual’s choice.
5.3.7 Hearing decisions must be based exclusively on evidence introduced at the hearing.
5.3.8 The record must consist only of:
5.3.8.1 The transcript or recording of testimony and exhibits;
5.3.8.2 All papers and requests filed in the proceeding; and
5.3.8.3 The decision of the hearing officer.
5.3.9 The impartial decision must:
5.3.9.1 Summarize the facts;
5.3.9.2 Identify the regulations pertinent to the decision; and
5.3.9.3 Specify the reasons for the decisions.
5.3.10 The hearing officer shall:
5.3.10.1 Render a written decision within thirty business days of the hearing and notify the individual and the Department.
5.3.10.2 Notify the parties that this is the final decision of the Department with the right to an appeal pursuant to the Administrative Procedures Act, 29 Del.C. Ch. 101.
26 DE Reg. 107 (08/01/22)
APPENDIX A
MODULE: The Nursing Assistant Role and Function
COMPETENCIES:
26 DE Reg. 107 (08/01/22)
MODULE: Environmental Needs of the Resident/Patient
COMPETENCIES:
MODULE: Psychosocial Needs of the Resident/Patient
COMPETENCIES:
MODULE: Physical Needs of the Resident/Patient
COMPETENCIES:
5 DE Reg. 1908 (04/01/02)
6 DE Reg. 1505 (05/01/03)
8 DE Reg. 1014 (01/01/05)
14 DE Reg. 169 (09/01/10)
15 DE Reg. 192 (08/01/11)
15 DE Reg. 1010 (01/01/12)
16 DE Reg. 632 (12/01/12)
20 DE Reg. 901 (05/01/17)
26 DE Reg. 107 (08/01/22)
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