California Nursing Home Administrator — Requirements & Free Practice

The authority has not published an examination outline; the practice questions follow the scope of the existing question bank.

• Professional licensure and accountability

  • Licensure, examination, renewal, reporting, and discipline
• Facility governance and administration

  • Licensee and administrator duties, delegation, staffing, and policies
• Resident rights and transitions

  • Admission, transfer, discharge, bed hold, consent, rights, and personal funds
• Clinical oversight and care planning

  • Physician services, medical direction, assessment, care plans, and notifications
• Nursing care, restraints, and infection control

  • Medication administration, direct care, restraints, isolation, cleaning, and staffing
• Pharmaceutical services

  • Pharmacy access, drug orders, storage, records, controlled drugs, and disposal
• Dietetic services

  • Food service, menus, storage, sanitation, therapeutic diets, and supplies
• Activities and interdisciplinary services

  • Activity programming, individualized plans, staff duties, committees, and training
• Records, reporting, and emergency preparedness

  • Health records, unusual occurrences, communicable disease, disaster, and fire procedures
• Physical environment and safety

  • Patient rooms, privacy, housekeeping, utilities, waste, gases, and emergency power

• Care, Services, and Supports (39%)

  • Quality of Care: Medical and Nursing Care Practices
  • Quality of Care: Medication Management and Administration
  • Quality of Care: Disease Management (e.g., acute vs. chronic conditions)
  • Quality of Care: Nutrition and Hydration (e.g., specialized diets)
  • Quality of Care: Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs)
  • Quality of Care: Rehabilitation and Restorative Programs
  • Quality of Care: Care Recipient Assessment and Interdisciplinary Care Planning
  • Quality of Care: Clinical and Medical Records and Documentation Requirements (e.g., storage, retention, destruction)
  • Quality of Care: Medical Director
  • Quality of Care: Emergency Medical Services (e.g., CPR, first aid, Heimlich maneuver, AED)
  • Quality of Care: Transition of Care (e.g., admission, move-in, transfer, discharge, and move-out)
  • Quality of Care: Basic Healthcare Terminology
  • Quality of Life: Psychosocial Needs (e.g., social, spiritual, community, cultural)
  • Quality of Life: Person-Centered Care and Comprehensive Care Planning
  • Quality of Life: Care Recipient Bill of Rights and Responsibilities
  • Quality of Life: Care Recipient Safety (e.g., fall prevention, elopement prevention, adverse events)
  • Quality of Life: Care Recipient (and Representative) Grievance, Conflict, and Dispute Resolution
  • Quality of Life: Care Recipient Advocacy (e.g., Ombudsman, resident and family council)
  • Quality of Life: Care Recipient Decision-Making (e.g., capacity, power of attorney, guardianship, conservatorship, code status, advance directives, ethical decision-making)
  • Quality of Life: Care Recipient (and Representative) Satisfaction
  • Quality of Life: Recognition of Maltreatment (e.g., abuse, neglect, exploitation)
  • Quality of Life: Mental and Behavioral Health (e.g., cognitive impairment, depression, social support systems)
  • Quality of Life: Trauma-Informed Care (e.g., PTSD)
  • Quality of Life: Pain Management
  • Quality of Life: Death, Dying, and Grief
  • Quality of Life: Restraint Usage and Reduction
  • Quality of Life: Foodservice (e.g., choice and menu planning, dietary management, food storage and handling, dining services)
  • Quality of Life: Social Services Programs
  • Quality of Life: Therapeutic Recreation and Activity Programs
  • Quality of Life: Community Resources, Programs, and Agencies (e.g., meals on wheels, housing vouchers, Area Agencies on Aging, Veterans Affairs)
  • Ancillary Services: Hospice and Palliative Care
  • Ancillary Services: Specialized Medical Equipment (e.g., oxygen, durable medical equipment)
  • Ancillary Services: Transportation for Care Recipients
  • Ancillary Services: Telemedicine (e.g., e-health)
  • Ancillary Services: Diagnostic Services (e.g., radiology, lab services)
  • Ancillary Services: Dental and Oral Care Services
  • Ancillary Services: Healthcare Partners and Clinical Providers (e.g., MD/DO, Nurse Practitioner, Psychiatrist, Podiatrist, Dentist)
  • Ancillary Services: Volunteer Programs
• Operations (37%)

  • Financial Management: Budgeting and Forecasting
  • Financial Management: Financial Analysis (e.g., ratios, profitability, debt, revenue mix, depreciation, operating margin, cash flow)
  • Financial Management: Revenue Cycle Management (e.g., billing, accounts receivable, accounts payable, collections)
  • Financial Management: Financial Statements (e.g., income/revenue statement, balance sheet, statement of cash flows, cost reporting)
  • Financial Management: Revenue and Reimbursement (e.g., PDPM, PDGM, ACOs, HMOs, Medicaid, private payors)
  • Financial Management: Financial Reporting Requirements (e.g., requirements for not-for-profit, for-profit, and governmental providers)
  • Financial Management: Integration of Clinical and Financial Systems (e.g., EMR/HER, MDS)
  • Financial Management: Internal Financial Management Controls (e.g., segregation of duties, access)
  • Financial Management: Supply-Chain Management (e.g., inventory control)
  • Financial Management: Resident Trust Accounts for Personal Funds
  • Risk Management: OSHA Rules and Regulations
  • Risk Management: Workers’ Compensation
  • Risk Management: Ethical Conduct and Standards of Practice
  • Risk Management: Compliance Programs
  • Risk Management: Risk Management Process and Programs
  • Risk Management: Quality Improvement Processes (e.g., root cause analysis, PDCA/PDSA)
  • Risk Management: Scope of Practice and Legal Liability
  • Risk Management: Internal Investigation Protocols and Techniques (e.g., incidents, adverse events)
  • Risk Management: Mandatory Reporting Requirements (e.g., incidents, adverse events, abuse, neglect, financial exploitation, fraud)
  • Risk Management: Insurance Coverage (e.g., liability, property)
  • Risk Management: Healthcare Record Requirements (e.g., confidentiality, disclosure, safeguarding, HIPAA, HITECH)
  • Risk Management: Security (e.g., cameras, monitoring systems, locks, staff location reporting)
  • Risk Management: Contracted Services (e.g., roles, responsibilities, oversight, background checks)
  • Human Resources: Federal Human Resources Laws, Rules, and Regulations (e.g., ADA, FMLA, Wage and Hour, FLSA)
  • Human Resources: Selection and Hiring Practices (e.g., EEOC, interviewing, adverse impact, protected classes, occupational qualifications)
  • Human Resources: Compensation and Benefits Programs (e.g., time off, healthcare insurance, employee pay and payroll)
  • Human Resources: Organizational Staffing Requirements and Reporting (e.g., PBJ)
  • Human Resources: Staff Certification and Licensure Requirements
  • Human Resources: Professional Development (e.g., maintenance of credentials, continuing education)
  • Human Resources: Employee Training and Orientation
  • Human Resources: Performance Evaluation
  • Human Resources: Human Resource Policies (e.g., drug-free workplace, discipline, job classification, photography and video, social media usage, mobile phone usage)
  • Human Resources: Employee Record-Keeping Requirements
  • Human Resources: Employee Grievance, Conflict, and Dispute Resolution
  • Human Resources: Employee Satisfaction, Engagement, and Retention
  • Human Resources: Cultural Competence and Diversity Awareness
  • Human Resources: Labor Relations (e.g., union, collective bargaining [CBA], contract/pool staff)
• Environment and Quality (13%)

  • Care Setting: Federal Codes and Regulations for Building, Equipment, Maintenance, and Grounds
  • Care Setting: Person-Centered Environment (e.g., home-like environment)
  • Care Setting: Safety and Accessibility (e.g., ADA, safety data sheets)
  • Care Setting: Facility Management and Environmental Services
  • Care Setting: Information Systems Infrastructure (e.g., configurations, data security, technical controls)
  • Care Setting: Preventative and Routine Maintenance Programs (e.g., pest control, equipment, mechanical systems)
  • Care Setting: Infection Control and Sanitation (e.g., linens, kitchen, hand washing, healthcare-acquired infections, hazardous materials)
  • Care Setting: Disaster and Emergency Planning, Preparedness, Response, and Recovery (e.g., Appendix Z)
  • Regulatory Compliance: Federal Healthcare Laws, Rules, and Regulations
  • Regulatory Compliance: Government Programs and Entities (e.g., Medicare, Medicaid, waivers)
  • Regulatory Compliance: Certification and Licensure Requirements for the Organization
• Leadership and Strategy (11%)

  • Leadership: Organizational Structures (e.g., departments, functions, systemic processes)
  • Leadership: Organizational Change Management
  • Leadership: Organizational Behavior (e.g., organizational culture, team building, group dynamics)
  • Leadership: Leadership Principles (e.g., communication, styles, mentoring, coaching, personal professional development)
  • Leadership: Governance (e.g., board of directors, governing bodies, corporate entities, advisory boards)
  • Leadership: Professional Advocacy and Governmental Relations
  • Organizational Strategy: Mission, Vision, and Value Statements
  • Organizational Strategy: Strategic Business Planning (e.g., new lines of service, succession management, staffing pipeline)
  • Organizational Strategy: Business Analytics (e.g., evidence-based practice, data analytics)
  • Organizational Strategy: Business Development (e.g., sales, marketing, partnerships, ACOs, contracts and agreements, negotiations)
  • Organizational Strategy: Public Relations and External Stakeholders (e.g., hospitals, referrals sources, local community, donors)

• Care, Services, and Supports (45%)

  • Quality of Care: Medical and Nursing Care Practices
  • Quality of Care: Medication Management and Administration
  • Quality of Care: Nutrition and Hydration (e.g., specialized diets)
  • Quality of Care: Rehabilitation and Restorative Programs
  • Quality of Care: Care Recipient Assessment and Interdisciplinary Care Planning
  • Quality of Care: Clinical and Medical Records and Documentation Requirements (e.g., storage, retention, destruction)
  • Quality of Care: Medical Director
  • Quality of Care: Emergency Medical Services (e.g., CPR, first aid, Heimlich maneuver, AED)
  • Quality of Care: Transition of Care (e.g., admission, move-in, transfer, discharge, and move-out)
  • Quality of Life: Psychosocial Needs (e.g., social, spiritual, community, cultural)
  • Quality of Life: Person-Centered Care and Comprehensive Care Planning
  • Quality of Life: Care Recipient Bill of Rights and Responsibilities
  • Quality of Life: Care Recipient Safety (e.g., fall prevention, elopement prevention, adverse events)
  • Quality of Life: Care Recipient (and Representative) Grievance, Conflict, and Dispute Resolution
  • Quality of Life: Care Recipient Advocacy (e.g., Ombudsman, resident and family council)
  • Quality of Life: Care Recipient Decision-Making (e.g., capacity, power of attorney, guardianship, conservatorship, code status, advance directives, ethical decision-making)
  • Quality of Life: Recognition of Maltreatment (e.g., abuse, neglect, exploitation)
  • Quality of Life: Mental and Behavioral Health (e.g., cognitive impairment, depression, social support systems)
  • Quality of Life: Trauma-Informed Care (e.g., PTSD)
  • Quality of Life: Pain Management
  • Quality of Life: Death, Dying, and Grief
  • Quality of Life: Restraint Usage and Reduction
  • Quality of Life: Foodservice (e.g., choice and menu planning, dietary management, food storage and handling, dining services)
  • Quality of Life: Social Services Programs
  • Quality of Life: Therapeutic Recreation and Activity Programs
  • Ancillary Services: Hospice and Palliative Care
  • Ancillary Services: Transportation for Care Recipients
  • Ancillary Services: Diagnostic Services (e.g., radiology, lab services)
  • Ancillary Services: Dental and Oral Care Services
  • Ancillary Services: Healthcare Partners and Clinical Providers (e.g., MD/DO, Nurse Practitioner, Psychiatrist, Podiatrist, Dentist)
  • Ancillary Services: Volunteer Programs
• Operations (28%)

  • Financial Management: Revenue and Reimbursement (e.g., PDPM, PDGM, ACOs, HMOs, Medicaid, private payors)
  • Financial Management: Financial Reporting Requirements (e.g., requirements for not-for-profit, for-profit, and governmental providers)
  • Financial Management: Integration of Clinical and Financial Systems (e.g., EMR/EHR, MDS)
  • Financial Management: Resident Trust Accounts for Personal Funds
  • Risk Management: OSHA Rules and Regulations
  • Risk Management: Compliance Programs
  • Risk Management: Scope of Practice and Legal Liability
  • Risk Management: Internal Investigation Protocols and Techniques (e.g., incidents, adverse events)
  • Risk Management: Mandatory Reporting Requirements (e.g., incidents, adverse events, abuse, neglect, financial exploitation, fraud)
  • Risk Management: Healthcare Record Requirements (e.g., confidentiality, disclosure, safeguarding, HIPAA, HITECH)
  • Risk Management: Security (e.g., cameras, monitoring systems, locks, staff location reporting)
  • Risk Management: Contracted Services (e.g., roles, responsibilities, oversight, background checks)
  • Human Resources: Organizational Staffing Requirements and Reporting (e.g., PBJ)
  • Human Resources: Staff Certification and Licensure Requirements
  • Human Resources: Professional Development (e.g., maintenance of credentials, continuing education)
  • Human Resources: Employee Training and Orientation
  • Human Resources: Performance Evaluation
  • Human Resources: Employee Record-Keeping Requirements
  • Human Resources: Cultural Competence and Diversity Awareness
• Environment and Quality (27%)

  • Care Setting: Federal Codes and Regulations for Building, Equipment, Maintenance, and Grounds
  • Care Setting: Person-Centered Environment (e.g., home-like environment)
  • Care Setting: Safety and Accessibility (e.g., ADA, safety data sheets)
  • Care Setting: Facility Management and Environmental Services
  • Care Setting: Preventative and Routine Maintenance Programs (e.g., pest control, equipment, mechanical systems)
  • Care Setting: Infection Control and Sanitation (e.g., linens, kitchen, hand washing, healthcare-acquired infections, hazardous materials)
  • Care Setting: Disaster and Emergency Planning, Preparedness, Response, and Recovery (e.g., Appendix Z)
  • Regulatory Compliance: Federal Healthcare Laws, Rules, and Regulations
  • Regulatory Compliance: Government Programs and Entities (e.g., Medicare, Medicaid, waivers)
  • Regulatory Compliance: Certification and Licensure Requirements for the Organization
  • Regulatory Compliance: Regulatory Survey and Inspection Process
  • Regulatory Compliance: Procedures for Informal Dispute Resolution (IDR)
  • Regulatory Compliance: Centers for Medicare and Medicaid Services (CMS) Quality Measures
  • Regulatory Compliance: Quality Assurance and Performance Improvement (QAPI)
  • Regulatory Compliance: Bed-Hold Requirements
  • Regulatory Compliance: Pre-Admission Screening Annual Review (PASRR)
  • Regulatory Compliance: Facility Assessment