03/09/2023

Survey Tip of the Week: Nurse Aide Performance Review

F-tag 947 requires that facilities address areas of weakness as determined in the nurse aides’ performance. Performance reviews are defined as the process used to evaluate the performance of staff on a periodic basis, which may be annually. The State Operations Manual Appendix PP further states that all facilities must develop, implement and permanently maintain an in-service training program for nurse aides that is appropriate and effective, as determined by nurse aide performance reviews [see §483.35(d)(7)] and the facility assessment as specified at §483.70(e). Changes to the facility’s resident population, the facility’s physical environment, staff turnover, and modifications to the facility assessment may necessitate ongoing revisions to the facility’s training program.

There are a variety of methods that could be used to provide training. For example, nurse aide training may be facilitated through any combination of in-person instruction, webinars (though, should not be webinars alone), and/or supervised practical training hours, and should be reflective of nurse aides’ performance reviews in order to address identified weaknesses. When able, each nurse aide should be evaluated based on individual performance, and the facility should develop training that can be utilized and beneficial to all nurse aide staff when applicable. 

Surveyors will determine compliance by asking the following:

• How has in-service education addressed any areas of weakness identified in performance reviews, including any special resident needs, or needs of residents with cognitive impairments?
• How does the facility evaluate nurse aide performance to determine what topics must be included in in-service training to address areas of weakness?
• How does the facility determine when training content must be updated (e.g., in order to remain consistent with current professional standards and guidelines)?
• What process does the facility have to encourage nurse aides to express concerns and request training in challenging situations? How does the facility respond to nurse aides’ concerns and requests?
• Does the facility’s nurse aide training ensure residents attain or maintain the highest practicable physical, mental, and psychosocial well-being as determined by resident assessments and individual plans of care?
• How does the facility assess nurse aides to determine if the training has been effective?

Additional information on the CMS guidance can be found in the State Operations Manual Appendix PP. Survey pathways can be found on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. LeadingAge continues to develop webinars and resources on the updated requirements of participation which will be located  on the LeadingAge learning hub. LeadingAge also continues to add QuickCasts on the regulatory groups. Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.  

For more information about the updated requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the April 12 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.