Form DS1853 "Training Program for Icf/DD-N Attendant" - California

What Is Form DS1853?

This is a legal form that was released by the California Department of Developmental Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2015;
  • The latest edition provided by the California Department of Developmental Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DS1853 by clicking the link below or browse more documents and templates provided by the California Department of Developmental Services.

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Download Form DS1853 "Training Program for Icf/DD-N Attendant" - California

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State of California—Health and Human Services Agency
Department of Developmental Services
TRAINING PROGRAM FOR ICF/DD-N ATTENDANT
Reset Form
Save As
DS 1853 (Rev. 06/2015)
DIRECTIONS: Complete this form and mail the original to the address to the right.
Department of Developmental Services
The signed, returned copy is your authorization to initiate and conduct your Attendant Training
Community Living Section
Program. Retain this signed and dated copy with your training manual. Proposed changes must
1600 Ninth Street, Room 320, MS 3-9
be submitted to the Department at the address to the right, and approval must be received by
Sacramento, CA 95814
you before changes are initiated.
Phone: (916) 654-1965
Name of Facility
Address
City
Age of Clients Served
Telephone
Director of Staff Development (attach copy of current license)
RN
LVN
Theory/Class
Clinical
MODULE/TOPIC
(minimum hours required)
(hours required)
MODULE 1
INTRODUCTION TO
Attendant responsibilities
Philosophy of client care
5
3
Nursing policies/procedures
Special needs of persons with developmental disabilities
Individual Service Plan
Special incidents, unusual occurrences
Legal issues, Confidentiality
Fire prevention, reporting procedures
Accident prevention
Disaster prevention
Activities of daily living
MODULE 2
HEALTH CARE SKILLS
Nursing policies and procedures
25
50
Attendant responsibilities
Basic anatomy and physiology
Basic nursing care
Activities of daily living
Signs and symptoms of illness
Prevention of disease, infection control
Personal hygiene and grooming
Skin care, prevention of decubiti
Care of the incontinent patient, perineal care
Nutrition, diets, fluid needs
First aid and immediate or temporary health concerns
CPR and relief from choking
Assistive devices, braces and splints
MODULE 3
DEVELOPMENTAL DISABILITIES AND TRAINING MODULES
The I.D. team, its process
15
The individual service plan, its development
32
Causes of developmental disabilities
Normal growth and development
Disruptions of normal growth, development
Principles of behavior intervention
Behavior shaping, behavior modification
Training techniques, positive and negative reinforcement
Socialization and recreational needs
Developmental programming; active treatment
Special services: occupation, physical, speech therapies
Assistive devices, braces and splints
Communication needs: devices, signs, sounds
MODULE 4
RECORDING, ASSESSING
Observation, documentation
5
15
Evaluation and assessments
Data collection
Data interpretation
TOTAL HOURS REQUIRED
50
100
State of California—Health and Human Services Agency
Department of Developmental Services
TRAINING PROGRAM FOR ICF/DD-N ATTENDANT
Reset Form
Save As
DS 1853 (Rev. 06/2015)
DIRECTIONS: Complete this form and mail the original to the address to the right.
Department of Developmental Services
The signed, returned copy is your authorization to initiate and conduct your Attendant Training
Community Living Section
Program. Retain this signed and dated copy with your training manual. Proposed changes must
1600 Ninth Street, Room 320, MS 3-9
be submitted to the Department at the address to the right, and approval must be received by
Sacramento, CA 95814
you before changes are initiated.
Phone: (916) 654-1965
Name of Facility
Address
City
Age of Clients Served
Telephone
Director of Staff Development (attach copy of current license)
RN
LVN
Theory/Class
Clinical
MODULE/TOPIC
(minimum hours required)
(hours required)
MODULE 1
INTRODUCTION TO
Attendant responsibilities
Philosophy of client care
5
3
Nursing policies/procedures
Special needs of persons with developmental disabilities
Individual Service Plan
Special incidents, unusual occurrences
Legal issues, Confidentiality
Fire prevention, reporting procedures
Accident prevention
Disaster prevention
Activities of daily living
MODULE 2
HEALTH CARE SKILLS
Nursing policies and procedures
25
50
Attendant responsibilities
Basic anatomy and physiology
Basic nursing care
Activities of daily living
Signs and symptoms of illness
Prevention of disease, infection control
Personal hygiene and grooming
Skin care, prevention of decubiti
Care of the incontinent patient, perineal care
Nutrition, diets, fluid needs
First aid and immediate or temporary health concerns
CPR and relief from choking
Assistive devices, braces and splints
MODULE 3
DEVELOPMENTAL DISABILITIES AND TRAINING MODULES
The I.D. team, its process
15
The individual service plan, its development
32
Causes of developmental disabilities
Normal growth and development
Disruptions of normal growth, development
Principles of behavior intervention
Behavior shaping, behavior modification
Training techniques, positive and negative reinforcement
Socialization and recreational needs
Developmental programming; active treatment
Special services: occupation, physical, speech therapies
Assistive devices, braces and splints
Communication needs: devices, signs, sounds
MODULE 4
RECORDING, ASSESSING
Observation, documentation
5
15
Evaluation and assessments
Data collection
Data interpretation
TOTAL HOURS REQUIRED
50
100
ATTENDANT TRAINING PROGRAM FOR ICF/DD-N
Student population:
Supervised clinical hours in an ICF/DD-N
_______ = projected number of students in the classroom/theory portion of the program
facility will be from __________ a.m. to
(maximum 15)
__________ a.m./p.m.
(must be between 6:00 a.m. and 8:00 p.m.)
_______ = number of instructors who will supervise clinical portion of the program
Note: Develop a lesson plan for EACH TOPIC under Module 1-4. Select ONE lesson from each Module 1-4 and submit to DDS for approval.
Each lesson plan must include the course content and document the manner of determining the student’s proficiency.
Clinical practice shall take place in an intermediate care facility/developmentally disabled-nursing and shall be conducted concurrently with
classroom instruction. During clinical practice there shall be no more than five (5) students to each instructor at any time.
If the facility has contracted for a training program to be administered by another provider (e.g. another facility, public educational institution or agen-
cy), indicate below the name of the provider of that program. Enclose a copy of the complete attendant care training plan, the prior program Approval
Notice for the submitted plan and a copy of the training agreement/contract.
Name ________________________________________________________________________________________________________________________
Street Address __________________________________________________ Telephone Number (
)
___________________________________
City ________________________________________________________________________________________________________________________________________
Name of Contact Person _____________________________________________________________________________________________________________________
Date Program Was Submitted ________________________________ By ___________________________________________________________________________
I affirm the foregoing information is true and correct
Signature of Director of Staff Development
Date
Authorization for the ICF/DD-N Attendant Training Program shall be given by the Department of Developmental Services, pursuant
to Business and Professions Code 2728. This authorization shall remain in effect unless changes are submitted by the facility or
unless cancelled in writing by the Department of Developmental Services.
FOR OFFICE USE ONLY
FOR OFFICE USE ONLY
Following modules approved by:
Following modules approved by:
Date:
Date:
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