What to Expect

What to Expect from an Administrator in Training (AIT) Program

The Administrator in Training (AIT) program is a structured learning experience designed to prepare future leaders for the challenges and responsibilities of managing a nursing home or long-term care community. During the program, participants can expect to:

Gain Hands-On Experience:
Work directly alongside experienced administrators and department heads to understand daily operations, from resident care and staffing to budgeting, compliance, and family relations.
Learn Regulatory and Compliance Standards:
Develop a strong understanding of state and federal regulations that govern long-term care facilities, including resident rights, safety standards, and quality improvement initiatives.
Build Leadership and Management Skills:
Learn how to lead teams, resolve conflicts, and make ethical decisions that balance resident well-being with operational efficiency.
Understand Financial and Business Operations:
Gain insight into budgeting, payroll, purchasing, and resource management to ensure the facility runs smoothly and sustainably.
Develop Communication and Interpersonal Skills:
Strengthen communication with residents, families, staff, and external partners to foster trust, transparency, and collaboration.
Receive Mentorship and Professional Guidance:
Work closely with a licensed preceptor who provides mentorship, feedback, and support throughout the internship journey.

Prepare for Licensure and Career Advancement:
Complete required training hours and competencies needed for licensure while building the confidence and professional foundation for a successful career in long-term care administration.

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Taking the Initiative

Taking initiative is a key quality of successful leaders in long-term care. As an Administrator in Training, it means stepping forward to learn, contribute, and lead—without waiting to be told. Initiative reflects motivation, curiosity, and a genuine commitment to residents, staff, and the overall mission of quality care.

What Taking Initiative Looks Like:

Engaging in Learning: Asking questions, seeking feedback, and actively observing how experienced leaders make decisions.
Volunteering for Tasks: Offering to help with projects, problem-solving, or process improvements that support the team and enhance resident care.
Identifying Opportunities: Noticing areas for improvement—such as communication gaps, workflow challenges, or staff morale—and proposing thoughtful, respectful solutions.
Demonstrating Accountability: Taking ownership of your work, following through on commitments, and showing reliability in every responsibility.
Leading by Example: Modeling professionalism, compassion, and a positive attitude that inspires others to do their best.

Why It Matters:
By taking initiative, AITs build confidence, earn trust, and develop the leadership mindset necessary for managing a successful nursing home. Initiative transforms learning into action—and action into meaningful impact on residents’ lives.

Plan-Do-Check-Act

(PDCA)

A practical quality-improvement method for Administrators in Training

PDCA is a continuous improvement cycle used in healthcare, business, and quality assurance. In nursing homes, it helps ensure resident care, operations, and compliance are always improving.

⭐ PDCA Example: Improving Dining Room Meal Delivery Accuracy

1️⃣ PLAN

Problem Identified:
Residents are frequently receiving the wrong meal items (wrong diet, missing items, or incorrect portions).

Goal:
Reduce meal tray errors from 10 per week to fewer than 3 per week within 45 days.

Plan:

Review how meal tickets are printed and delivered to dietary staff.
Add color-coded labels for special diets (e.g., pureed, mechanical soft, cardiac).
Re-educate dietary aides on reading diet orders before plating.
Start a tray-check process where 1 tray per cart is reviewed before leaving the kitchen.

2️⃣ DO

Put the plan in motion:

Begin printing color-coded tickets and attaching them to trays.
Conduct a 15-minute refresher with dietary staff on diet types.
Assign one dietary aide each shift to perform random tray checks.
Track any errors found before trays leave the kitchen.

3️⃣ CHECK

Review results:

Track the number of complaints or errors logged during meal service for 2 weeks.
Observe tray lines during peak times.
Ask CNAs if accuracy noticeably improved.

Findings:
Errors reduced from 10 per week to 5 per week, but still above goal.
Most errors involved missing items rather than wrong diets.

4️⃣ ACT

Adjust and improve:

Keep color-coded tickets—they worked well.
Add a “final check” position on high-volume meals (breakfast and dinner).
Create a simple checklist for aides: entrée, sides, beverage, utensils, adaptive equipment.
Continue monitoring weekly until the goal is met.

Why PDCA Matters for an AIT

PDCA helps you learn how to:

Identify issues
Fix problems quickly
Improve systems long-term
Prepare for surveys
Strengthen quality assurance programs
Build your leadership decision-making skills

It’s basically the core of QAPI (Quality Assurance & Performance Improvement) and is used in audits, POCs, meetings, and survey follow-ups.

DPH Survey

(DPH) Annual Survey is a comprehensive inspection conducted each year to ensure that nursing homes and long-term care facilities comply with both state and federal regulations. The survey evaluates all aspects of resident care, facility operations, and quality standards to protect the health, safety, and well-being of residents.

Purpose of the Survey

To verify compliance with Centers for Medicare & Medicaid Services (CMS) and Connecticut state regulations.
To ensure residents receive safe, effective, and compassionate care.
To identify areas where improvement is needed and ensure facilities take corrective actions when deficiencies are found.

What Surveyors Review

DPH surveyors typically evaluate:

Resident care practices, including nursing, dietary, therapy, and social services
Staffing levels, training, and competency
Medication administration and documentation
Infection prevention and control
Resident rights and quality of life
Physical environment and safety standards
Records, policies, and procedures for compliance

The Survey Process

1. Unannounced Visit:
The annual survey is unannounced, meaning facilities receive no prior notice.

2. Observation and Interviews:
Surveyors observe care, review medical records, and interview residents, families, and staff.

3. Exit Conference:
At the end of the visit, surveyors discuss findings with facility leadership.

4. Statement of Deficiencies (Form CMS-2567):
If any violations are identified, they are documented in a formal report.

5. Plan of Correction (POC):
The facility must submit a written plan detailing how each deficiency will be corrected and prevented from recurring.

Role of the Administrator in Training (AIT)

As an AIT, understanding the DPH Annual Survey process is essential. You should:

Be familiar with survey standards and the facility’s policies.
Observe how leadership prepares for and responds to surveys.
Participate in quality assurance meetings and audits that support continuous readiness.
Learn how to lead staff in maintaining compliance every day—not just when a survey is expected.

Audits

Audits are internal reviews conducted to evaluate how well a facility is complying with regulations, policies, and best practices. They help identify potential issues before they become survey deficiencies or impact resident care.
Regular audits demonstrate the facility’s commitment to quality assurance and continuous improvement.

Types of Audits May Include:

Clinical Audits: Review of nursing documentation, medication administration, infection control, or wound care practices.
Environmental Audits: Inspection of cleanliness, safety equipment, and maintenance standards.
Dietary Audits: Monitoring meal quality, sanitation, and compliance with dietary guidelines.
Personnel Audits: Ensuring employee credentials, training, and competencies are up to date.
Resident Rights Audits: Verifying that residents’ privacy, dignity, and autonomy are respected.

Purpose of Audits:

Detect issues early and correct them proactively.
Monitor the effectiveness of existing policies and procedures.
Ensure continuous readiness for state and federal surveys.
Support a culture of accountability and quality improvement.

References

Centers for Medicare & Medicaid Services (CMS). State Operations Manual, Appendix PP – Guidance to Surveyors.

CMS Nursing Home QAPI Guidelines. American College of Health Care Administrators (ACHCA). Administrator-in-Training Resources.

Centers for Medicare & Medicaid Services. Requirements of Participation for Long-Term Care Facilities.

Agency for Healthcare Research and Quality (AHRQ). TeamSTEPPS Long-Term Care Communication Tools.

LeadingAge & AHCA Training Resources for LTC Leadership.