c:lc:a Agenda Item #14.A.4. DATE: February 6,2012 Boar Members FROM: S pervising Nursing Education

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1 Agenda Item #14.A.4. c:lc:a ",TAT. OF CAL,II'OI'lN,A \ I BOARD OF VOCATIONAL NURSING & PSYCHIATRIC TECHNICIANS 2535 Capitol Oaks Drive, Suite 205, Sacramento, CA Phone (916) Fax (916) Web DATE: February 6,2012 TO: Boar Members FROM: he~~~./m-'1.s'fi.~,--q.,./ S pervising Nursing Education onsultant SUBJECT: Medical Career College, Fremont, Vocational Nursing Program Reconsideration of Provisional Accreditation and Request to Admit Students (Director: Marilyn Castillo, Fremont, Alameda County, Private) On February 18, 2010, the Board placed Medical Career College, Fremont, Vocational Nursing Program on provisional accreditation for the two - year period from February 18, 2010, through February 17, That action was taken due to the program's noncompliance with Section 2530 (I) of the Vocational Nursing Rules and Regulations, which states: "The program shall maintain a yearly average minimum pass rate on the licensure examination that does not fall below 10 percentage points of the state average pass rate for first time candidates of accredited vocational nursing schools for the same period. (1) Failure to maintain the required yearly average minimum pass rate for two years or eight consecutive quarters may be cause to place a program on provisional accreditation." The Board specified that Medical Career College Vocational Nursing Program must bring its average annual pass rate to no more than ten (10) percentage points below the state average annual pass rate for four (4) consecutive quarters by February 17, Reconsideration was scheduled for February 24, The following table shows the variance of the program's pass rates from the state average annual pass rates of first - time graduates of accredited vocational nursing programs for the past seventeen (17) consecutive quarters. This data substantiates the program's continued noncompliance with Section 2530(1) of the Vocational Nursing Rules and Regulations.

2 The program requests approval to admit 15 students into a day class commencing April 2, 2012, and graduating April 18, 2013, to replace students scheduled to graduate March 22, Additionally, the program requests approval to admit 15 students into an evening class commencing April 2, History of Prior Board Actions On May 12, 2006, the Executive Officer approved Medical Career College's request to begin a vocational nursing program with an initial class of 30 students on June 19, 2006 only, and approved the program curriculum for 1600 hours, including 630 theory, and 970 clinical hours. On July 10, 2007, the Executive Officer approved initial full accreditation for the Medical Career College Vocational Nursing Program for the period from July 10, 2007, through July 9, 2011, and issued a certificate accordingly; and approved the program's request to admit a full-time class of 30 students on August 20, 2007, only, to replace students graduating on August 8, 2007; and approved the program's request to admit a second full-time class of 30 students on October 1, 2007 only, with a projected graduation date of October 31, On February 27, 2008, the Executive Officer approved the program's request to admit 30 students on March 17, 2008, only, with an anticipated graduation date of May 8,

3 On June 4, 2008, the Executive Officer approved the program's request to admit 30 students on July 14, 2008 only, with an anticipated graduation date of August 21, On October 8, 2008, the Executive Officer approved the program's request to admit 15 students on December 1, 2008 only, graduating January 29,2010, to replace a full - time day class; and approved the program's request to admit 15 students on December 1, 2008 only, to replace a full-time evening class. Graduation of that class is scheduled for January 29, On November 13, 2008, the assigned consultant forwarded correspondence notifying the director that the program's average annual pass rates had fallen more than ten (10) percentage points below state average annual pass rates for the past four (4) consecutive quarters. The program was requested to submit a written plan for improving its NCLEX-PN@pass rates by December 13, The director reported that the program requires completion of the ATI tool as part of the program's curriculum review and NCLEX-PN@ preparation process. Additionally, the director noted that the program had hired consultants to work with faculty on professional development issues. On March 18, 2009, the assigned consultant forwarded correspondence notifying the director that the program's average annual pass rates had fallen more than ten (10) percentage points below state average annual pass rates for the past five (5) consecutive quarters. The director was requested to submit a copy of the program's detailed plan for improving the NCLEX-PN@ pass rates, the date the plan was implemented, and the effectiveness of the employed interventions by April 2, The director reported that the program received feedback that students were not following ATI requirements for completion of the Virtual ATI products that were added. The program switched to another review product offered by ATI, and students met with program consultants to review individualized reports regarding their progress. The program re-assigned faculty and hired an assistant director in an effort to strengthen student instruction. On April 21, 2009, the assigned consultant forwarded correspondence notifying the program director that the program's average annual pass rates had fallen more than ten (10) percentage points below state average annual pass rates for six (6) consecutive quarters. The program was requested to submit documentation verifying that the elements of the program's plan of correction had been implemented. The program was asked to send a full listing of student names, and specific documentation showing how each student met the admissions, screening and selection criteria for admission to the program by May 21, The program failed to submit the requested documentation. 3

4 On July 15, 2009, the director reported, "As part of our plan of correction, we replaced Instructors, enhanced our curriculum and were working on creating an Admissions Committee and new policies to be submitted for approval. Once approved, we are looking forward to a more successful student population, and once approved for our next class we plan on instituting and having an ongoing evaluation of improvement regarding our newly approved policies." On July 16, 2009, the Board received correspondence from the director and evidence that all students meet the admissions, screening and selection criteria. On August 19, 2009, the assigned consultant forwarded correspondence notifying the program director that the program's average annual pass rates had fallen more than ten (10) percentage points of state average annual pass rates for seven (7) consecutive quarters. The consultant requested submission of an analysis of the effects of the program improvement plan. On September 3, 2009, the Executive Officer denied the program's request for admission of a class of 30 students on September 21, 2009, with a projected graduation date of November 30, 2010, to replace students that graduated on May 1, This denial was based upon the program's average annual pass rate of 29%. The Executive Officer approved the program's admission of a class of 15 students on September 21, 2009, only, with a projected graduation date of November 30, 2010, only, to replace students that graduated on May 1, Additionally, the Executive Officer denied the program's request for admission of a class of 30 students on September 21, 2009, with a projected graduation date of November 30,2010, to replace students that graduated on August 21,2009. That denial was based upon the program's average annual pass rate of 29%, and historical Executive Officer approval of class sizes of 15 students. The Executive Officer approved the program's admission of a class of 15 students on September 21, 2009, only, with a projected graduation date of November 30,2010, only, to replace students that graduated on August 21, On October 12, 2009, the Board approved a new program director. On February 18, 2010, the Board placed Medical Career College, Fremont, Vocational Nursing Program on provisional accreditation for the two - year period from February 18, 2010, through February 17, The following corrections were required. 1. The Medical Career College Vocational Nursing Program must bring its licensure examination annual average pass rate to no more than ten (10) percentage points below the State annual average pass rate for four (4) consecutive quarters by February 17, The program must prepare and implement a written plan to improve its pass rate and make modifications to the plan as necessary based on the success or failure of the actions taken. That plan must include a comprehensive analysis of the 4

5 program, specific actions that will be taken to improve program pass rates, and timelines for expected results. The following elements must be addressed in the analysis: a. Current Student Enrollment. b. Admission Criteria. c. Screening and Selection Criteria. d. Terminal Objectives. e. Curriculum Objectives. f. Instructional Plan. g. Theory and Clinical Objectives for Each Course. h. Lesson Plans for Each Course. i. Textbooks. j. Attendance Policy. k. Remediation Policy. I. Evaluations of Theory and Clinical Faculty. m. Evaluations of Theory Presentations. n. Evaluations of Clinical Rotations and Their Correlation to Theory Presentations. o. Evaluation of Student Achievement. 3. The program must submit a follow-up report in ten (10) and twenty - two (22) months evaluating the effectiveness of any corrective actions taken by each element listed in number 2 above. 4. The program must comply with all accreditation standards in article 4 of the Vocational Nursing Practice Act, commencing at Business and Professions Code section 2880, and article 5 of the Board's regulations, commencing at California Code of Regulations, title 16, section On March 10, 2010, the Board forwarded correspondence to the program per certified and regular mail delineating actions taken by the Board relative to the program's placement on provisional accreditation. On March 16, 2010, the Board received verification of program receipt of the Notice of Change in Accreditation Status, dated March 10, 2010, from the U.S. Postal Service. On March 30, 2010, a new program director was approved. On June 26, 2010, the Executive Officer deferred action on the program's request to admit students to the Board for consideration at the September 16, 2010 meeting. This decision was based on the program's average annual pass rate of 33%. The consultant notified the director of the decision per telephone. September 1,.2010, the Executive Officer approved Medical Career College Vocational Nursing Program's request to admit a full- time day class of 15 students on September 27, 2010 only, with a projected graduation date of November 18, 2011, to replace full - time day students who graduated February 11, 2010; and 5

6 approved the program's request to admit a full - time evening class of 15 students on September 27, 2010 only, with a projected graduation date of November 18, 2011, to replace full - time evening students who graduated February 11, 2010; and required the program to obtain Board approval prior to the admission of each class. That decision was based on the program's average annual pass rate of 40%, seven percentage points improved since the previous quarter. On November 5, 2010, the Board received program correspondence requesting approval to admit a day and evening class. On December 13, 2010, the Board received electronic correspondence from the program director titled, "Program Response to Provisional Accreditation." On December 13, 2010, the assigned consultant forwarded correspondence advising the director that the submitted "Program Response to Provisional Accreditation," did not fully comply with the Board's decisions of February 18, The program was requested to submit all required documents by December 24, On December 23,2010, the Board received the director's electronic correspondence and revised "Program Response to Provisional Accreditation." January 13, 2011, the Supervising Nursing Education Consultant sent correspondence to the director requesting the submission of documents for Board presentation. On January 24, 2011, copies of the program's report were received for dissemination to Board members. On February 25, 2011, the Board considered the program's request to admit students. The Board approved the program's admission of the following. a. Fifteen (15) students into a day class commencing March 7, 2011, and graduating March 22, 2012, to replace students scheduled to graduate February 10,2011;and b. Fifteen (15) students into an evening class commencing March 7, 20111, and graduating March 22, 2012, to replace students that graduated October 28, The program was required to admit no further students unless approved by the full Board. Additionally, the program was required to bring its average annual pass rate to no more than ten (10) percentage points below the State average annual pass rate by February 28, Additionally, the Board directed issuance of a Revised Notice of Noncompliance and Requirements for Correction to reflect: a. Prior violations relative to the program's annual average pass rate on the National Council Licensure Examination for PracticalNocational Nurses (NCLEX/PN) shall be corrected by February 28,2012; and 6

7 b. Compliance with all accreditation standards is required. Reconsideration of provisional accreditation was scheduled for February 24,2012. On April 5, 2011, the Board forwarded, per certified and regular mail, a Revised Notice of Noncompliance and Requirements for Correction. On April 13, 2011, the Board received the program's signed Acknowledgement of Change in Accreditation Status. The document was signed by the program director on April 7, On December 2, 2011, the Board received program correspondence and the required follow - up report specified in the Notice dated April 5, Information contained therein indicated commencement of the 15 students approved on February 25, 2011 to replace students that graduated February 10, 2011 was delayed to July 18,2012. On January 23, 2012, the assigned consultant sent correspondence requesting submission of documents for dissemination to Board members. On January 27, 2012, copies of the program's report were received for dissemination to Board members. Enrollment The program offers full - time day and evening classes that are 53 weeks in length. Board approval is required prior to the admission of each class. The enrollment table below presents the pattern of admissions for current and proposed classes. The following table represents current and projected student enrollment based on current and proposed class starts and completions. The table indicates a maximum enrollment of 59 students during the period December 2008 through April ENROLLMENT DATA DATES #Students Adniitt~d. 12/08 AM /08 PM =29 9/09 PM = 44 1/10 AM = =45 7

8 . CLASS DATES.... '.. ENROLLMENT DATA 1::.Start.I-; 'r'. 'c....,' Mmltbt~:.,. 2/10 (12/08 PM Class),""",',;...:...'; #Students...,:,;:,: :ii;:::~,.' ',:.. i..... '.... I) 1ft';' :~.\ = 30 9/10 AM =40 9/10 PM = 49 10/ = 34 (9/09 PM Class) 2111 (1/10 AM Class) = =29 7/ = (Proposed AM) 4/12 (I PM) 11/11 (9/10 AM Class) 11/11 (9/10 PM Class) 3112 (3/11 AM Class 8/12 J7/11~Class) = = = = = = 30 Licensing Examination Statistics The following statistics, furnished by Pearson VUE, and published by the National Council of State Boards of Nursing as "Jurisdictional Summary of All First-Time Candidates Educated in Member Board Jurisdiction," for the period January 2008 through December 2011, specify the pass percentage rates for graduates of Medical Career College Vocational Nursing Program on the National Council Licensure Examination for PracticalNocational Nurses (NCLEX-PN ). 8

9 NCLEX PN'" Licensure Examination Data.. Quarterly Statistics AnnuafStatistics'. Program State State # # % Average Average Quarter Quarterly Candidates Passed Passed Annual Annual Pass Rate Pass Rate Pass Rate Oct - Dec % 76% 35% 76% Jan Mar % 76% 36% 76% Apr Jun % 70% 35% 75% Jul - Sep % 75% 33% 74% Oct - Dec 2008 No Candidates Tested 73% 33% 73% Jan - Mar 2009 No Candidates Tested 70% 0% 72% Apr - Jun % 71% 29% 70% July - Sep % 74% 37% 72% Oct - Dec % 76% 37% 73% Jan - Mar % 76% 33% 74% Apr - Jun % 74% 40% 75% Jul- Sep % 76% 42% 75% Oct - Dec % 77% 39% 76% Jan - Mar % 82% 52% 77% Apr - Jun % 71% 40% 76% Jul - Sep _ - 67% 74% 41% 77% Oct - Dec % 74% 52% 75% The Annual Pass Rate changes every quarter. It is calculated by dividing the number of candidates who passed during the current and previous three-quarters by the number of candidates who tested during the same period. If no data is available for the relevant period, the statistic is carried over from the last quarter for which data is available. Based on the most recent data available (October - December 2011), the program's average annual pass rate is 52%. The California average annual pass rate for graduates from accredited vocational nursing programs who took the NCLEX-PN@ for the first time during the same period is 75%. The pass rate for the Medical Career College Vocational Nursing Program is 23 percentage points below the state average annual pass rate. Faculty and Facilities Section 2534(d) of the Vocational Nursing Rules and Regulations states: "For supervision of clinical experience, there shall be a maximum of 15 students for each instructor." 9

10 The program's Board - approved faculty totals seven (7), including the program director. The director has 100% administrative duties. Of the total faculty, six (6) are approved to teach in the clinical area. Based on a maximum enrollment of 59 students, four (4) instructors are needed. Therefore, the number of faculty is adequate for the current and proposed enrollment. Section 2534(b) of the Vocational Nursing Rules and Regulations states: "Schools shall have clinical facilities adequate as to number, type, and variety of patients treated, to provide clinical experience for all students in the areas specified by Section There must be available for student assignment, an adequate daily census of patients to afford a variety of clinical experiences consistent with competency-based objectives and theory being taught." The program's clinical facilities are adequate as to type and variety of patients treated to enable current and proposed students to meet clinical objectives in accordance with Section 2534(b) of the Vocational Nursing Rules and Regulations. Other Considerations As noted previously, the Board placed the Medical Career College Vocational Nursing Program on provisional accreditation on February 18, 2010, due to the performance of program graduates on the NCLEX-PN. At that time, the program had an average annual pass rate of 37%. Further, the program's average annual pass rates had been more than ten (10) percentage points below state average annual pass rates for eight (8) consecutive quarters. As such, the program was noncompliant with section 2530 (I) of the Vocational Nursing Rules and Regulations. (See Attachment A) On March 10, 2010, the assigned consultant forwarded correspondence per certified and regular mail notifying the program of the Board's action placing the program on provisional accreditation (see Attachment B). On March 16, 2010, the Board received verification of program receipt of the Notice of Change in Accreditation Status, dated March 10,2010, from the U.S. Postal Service (see Attachment C). On March 30, 2010, a new program director was approved. On April 5, 2010, the Board received correspondence from the director requesting approval to admit two (2) classes. The assigned consultant discussed the director's request and strongly recommended the director implement strategies to achieve sustained improvement in student achievement. On June 26, 2010, the Executive Officer deferred action on the program's request to admit students for Board consideration at the September 16, 2010 meeting. This decision was based on the program's average annual pass rate of 33%. The consultant notified the director of the decision. For the period January - March 2010, the program's quarterly pass rate was 10%; the program's average annual pass rate was 33%. The California average annual pass 10

11 rate for graduates from accredited vocational nursing programs completing the NCLEX PN for the first time during the same period was 74%. Therefore, the program's average annual pass rate was 41 percentage points below the state average annual pass rate. For the period April - June 2010, the program's quarterly pass rate improved to 75%; the average annual pass rate improved to 40%. The California average annual pass rate for graduates from accredited vocational nursing programs who completed the NCLEX-PN for the first time during the same period was 75%. Therefore, the program's average annual pass rate was 35 percentage points below the state average annual pass rate. On September 1, 2010, the Executive Officer approved the program's request to admit a full - time day class of 15 students and a full - time evening class of 15 students on September 27, This decision was based on the program's improved quarterly and average annual pass rate statistics. For the period July - September 2010, the program's quarterly pass rate declined to 50%; the average annual pass rate was 42%. The California average annual pass rate for 2raduates from accredited vocational nursing programs who completed the NCLEX PN for the first time during the same period is 75%. Therefore, the program's average annual pass rate was 33 percentage points below the state average annual pass rate. On November 5, 2010, the Board received the program's request for approval to admit two (2) classes. Specifically, the program proposed the admission of a day class of 15 students and an evening class of 15 students, both classes to commence March 22, On December 13, 2010, the Board received the program's electronic correspondence titled, "Program Response to Provisional Accreditation." Upon analysis, the assigned consultant identified that the program's response was not fully compliant with the Board's decisions of February 18, Additional information was requested. On December 23, 2010, the Board received the director's electronic correspondence and revised, "Program Response to Provisional Accreditation." On January 24, 2011, copies of the program's report were received for dissemination to Board members. As presented therein, the program reported implementation of the following interventions: ~ Revised Admission Criteria. As presented, the program's admission criteria were revised to require applicants to complete the Test of Essential Academic Skills (TEAS). Additionally, the director reported that applicants for admission must have completed two (2) prerequisite classes, such as Anatomy & Physiology and Medical Terminology. ~ Revised Instructional Plan. 11

12 The director reported the following revisions in its instructional plan. 1. Improved correlation between presented theory and clinical instruction. 2. Revision of examinations to reflect the style and format of examination items on the NCLEX/PN. 3. ATI and HESI Assessment Tests have been incorporated throughout the curriculum. 4. Increased emphasis placed on critical thinking. 5. Clinical simulation added to enhance theoretical presentation.» Identification of Students with Performance Deficits. The director reported that all students are assessed on a weekly basis to identify academic strengths and weaknesses. Additionally, the program reported its graduation criteria have been revised to require students to score 80% on a comprehensive exit examination.» Revised Attendance Policy. The director reported the following revisions in its Attendance Policy. 1. Students are required to contact instructors and establish a remediation plan for achievement of unmet objectives. 2. Students are required to participate in scheduled Skills Lab.» Revised Remediation Policy. The director reported revision of its Remediation Policy to require placement of students on academic probation for grades below 75%.» Adequacy of Instructional Methods and Materials. The program reported workshops and seminars have been conducted to improve the development of assigned faculty. For the period October - December 2010, the program's quarterly pass rate declined to 0%; the average annual pass rate was 39%. The California average annual pass rate for graduates from accredited vocational nursing programs who completed the NCLEX-PN for the first time during the same period was 76%. Therefore, the program's average annual pass rate was 37 percentage points below the state average annual pass rate. On February 25, 2011, the Board reconsidered the program's accreditation status and request to admit students (see Attachment D). The Board continued provisional accreditation and approved the program's admission of the following. 12

13 a. Fifteen (15) students into a day class commencing March 7, 2011, and graduating March 22, 2012, to replace students scheduled to graduate February 10, 2011; and b. Fifteen (15) students into an evening class commencing March 7, 20111, and graduating March 22, 2012, to replace students that graduated October 28, The program was required to admit no further students unless approved by the full Board. Additionally, the program was required to bring its average annual pass rate to no more than ten (10) percentage points below the State average annual pass rate by February 28, The Board directed issuance of a Revised Notice of Noncompliance and Requirements for Correction to reflect: a. Prior violations relative to the program's annual average pass rate on the National Council Licensure Examination for PracticalNocational Nurses (NCLEX/PN) shall be corrected by February 28,2012; and b. Compliance with all accreditation standards is required. Reconsideration of provisional accreditation was scheduled for February 24,2012. On April 5, 2011, the Board forwarded to the program a revised Notice of Noncompliance and Requirements for Correction (see Attachment E). On April 13, 2011, the Board received the program' signed Acknowledgement of Change in Accreditation Status. The document was signed by the program director on April 7, (See Attachment F) For the period January - March 2011, the program's quarterly pass rate improved to 60%; the average annual pass rate improved to 52%. The California average annual pass rate for graduates from accredited vocational nursing programs who completed the NCLEX-PN for the first time during the same period was 77%. As such, the program's average annual pass rate was 25 percentage points below tl;1e state average annual pass rate. For the period April - June 2011, the program's quarterly pass rate declined to 29%; the average annual pass rate declined to 40%. The California average annual pass rate for graduates from accredited vocational nursing programs who completed the NCLEX-PN for the first time during the same period was 76%. As such, the program's average annual pass rate was 36 percentage points below the state average annual pass rate. For the period July - September 2011, the program's quarterly pass rate improved to 67%; the average annual pass rate improved to 41%. The California average annual pass rate for graduates from accredited vocational nursing programs who completed the NCLEX-PN for the first time during the same period was 77%. Therefore, the program's average annual pass rate was 36 percentage points below the state average annual pass rate. 13

14 On December 2, 2011, the Board received the program's follow - up report. The director reported that the program continued implementation of the previously reported plan. (See Attachment G) In summary, the program has failed to bring its average annual pass rate to no more than ten (10) percentage points below the State average annual rate for four (4) consecutive quarters, as required. The director has reported implementation of interventions to address students' identified deficits in theoretical knowledge and clinical performance. However, it must be noted that the program's pass rates do not evidence sustained improvement. Specifically, program performance statistics evidence that the program's average annual pass rates have been more than ten (10) percentage points below the State average annual pass rates for seventeen (17) consecutive quarters. On February 18, 2010, the Board placed the program on provisional accreditation from February 1, 2010 through September 30, The Board directed the program to bring its average annual pass rate to no more than ten (10) percentage points below the State annual average pass rate for four (4) consecutive quarters by February 17, At that time, the program's average annual pass rate was 37%. Since placement on provisional accreditation, published program performance statistics confirm that 57 program graduates have completed the NCLEX-PN. Of the total tested, 44% of the program's graduates (25 graduates) passed; 56% (32 graduates) failed. Based on the most recent reporting period (October - December 2011), the program's quarterly pass rate is 67%; the program's average annual pass rate pass is 52%, an increase of 15 percentage points since placement on provisional accreditation. As such, the program's current average annual pass rate is 23 percentage points below the state average annual pass rate. On January 23, 2012, the Board forwarded correspondence requesting the submission of documents for dissemination to Board members (see Attachment H). On January 27, 2012, the Board received copies of the program's report for dissemination to Board members (see Attachment I). Recommendations: 1. Approve the program's request to admit 15 students into a day class commencing April 2, 2012 only, graduating April 22, 2013, to replace a class that scheduled to graduate March 22, Approve the program's request to admit 15 students into an evening class commencing April 2, 2012 only, graduating April 22, Require the program to admit no additional students unless approved by the full Board. 4. Extend the Medical Career College Vocational Nursing Program's Provisional Accreditation for the one - year period from February 18, 2012 through February 28, 2013, and issue a certificate, and issue a notice to the program to identify specific 14

15 areas of non compliance and requirements for correction as referenced in Section (e) of the California Code of Regulations (see Attachment J. 5. Require the program to submit a follow-up report in nine months, but no later than November 1, The report must include a comprehensive analysis of the program, specific actions taken to improve program pass rates, timeline for implementation, and the effect of employed interventions. The report must address all elements as identified in the Notice of Change in Accreditation Status dated April 5, Require the program to bring its average annual pass rate to no more than ten (10) percentage points below the State average annual pass rate by February 28, Require the program to comply with all accreditation standards in Article 4 of the Vocational Nursing Practice Act, commencing at Business and Professions Code Section 2880, and Article 5 of the Board's Regulations, commencing at California Code of Regulations, Title 16, Section Require the program to demonstrate incremental progress in correcting the violations. If the program fails to satisfactorily demonstrate incremental progress, the full Board may revoke the program's accreditation. 9. Failure to take any of these corrective actions may cause the full Board to revoke the program's accreditation. 10. Place the program on the February 2013 Board agenda for reconsideration of provisional accreditation. Rationale: As noted previously, the program was placed on provisional accreditation on February 18, 2010 through February 17, 2012, due to noncompliance with regulatory requirements relative to performance pass rates. Specifically, the program's average annual pass rates have been more than ten (10) percentage points below the State annual pass rates for thirteen (13) consecutive quarters. The Board directed that the program shall bring its average annual pass rate to no more than ten (10) percentage points below the State annual average pass rate for four (4) consecutive quarters by February 17, At that time, the program's average annual pass rate was 37%. The following table presents the program's pass rates since placement on provisional accreditation. 15

16 Based on reported performance statistics, 143 program graduates completed the NCLEX/PN from October 2007 through December 2011 Of the total program graduates tested, 39% (56 graduates) passed; 61% (87 graduates) failed the NCLEX/PN. Since placement on provisional accreditation in February 2010, published program performance statistics confirm that 57 program graduates completed the NCLEX-PN. Of the total tested, 44% of the program's graduates (25 graduates) passed; 56% (32 graduates) failed. The director has reported implementation of strategies to improve student achievement and program pass rates. During the past four (4) consecutive quarters, the program's quarterly pass rates have varied. The average annual pass rates have also varied. However, it is noted that over the last two (2) consecutive quarters, the program's quarterly pass rate has remained less than ten (10) percentage points below the State quarterly pass rate. It is further noted that the program's average annual pass rate has increased 15 percentage points since placement on provisional accreditation. Such improvement supports the recommendation to extend provisional accreditation through February 28, Attachment A: Attachment B: Attachment C: Attachment D: Attachment E: Attachment F: Attachment G: Attachment H: Attachment I Attachment J: Board Report Dated February 2,2010; Presented February 18, Notice of Change in Accreditation Status Dated March 10, Verification of Program Receipt of Notice Received March 16, Board Report Dated February 9, 2011; Presented February 18, Notice of Change in Accreditation Status Dated April 5, Program Acknowledgement of Change in Accreditation Status, signed April 7, 2011; Received by Board on April 13, Program Correspondence Dated November 30,2011; Received December 2,2011. Board Correspondence Dated January 23, Program Report Received January 27, Draft Notice of Change in Accreditation Status. 16

17 Agenda Item # 14.A.4. Attachement A STATE 0 F CALIFORNIA S'A T' ANI) CUNCScJMl~R SCHv,r..':I' U A:"'~f-r--JCY AR-'JUI: I '.3I~f IWARze>..;E:GGE:R, GUVfRNOH BOARD OF VOCATIONAL NURSING & PSYCHIATRIC TECHNICIANS c::ica 2535 Capitol Oaks Drive, Suite 205, Sacramento, CA OEPARH.~ENr or CONSUMER Af-ft.:RS ~ Phone (916) Fax (916) I Web DATE: February 2,2010 TO: Board Members FROM: SUBJECT: Anne Powers, Ph.D., R.N. Nursing Education Consultant Medical Career College Vocational Nursing Program - Consideration of Placement on Provisional Accreditation (Director: Mary Pat Bonham, Fremont, Alameda County, Private) Medical Career College Vocational Nursing Program is presented to the Board for consideration of placement on provisional accreditation. In accordance with Section (c) of the Vocational Nursing Rules and Regulations, "The Board may place any program on provisional accreditation when a program does not meet all requirements as set forth in this chapter and in Section " Section 2530(1) of the Vocational Nursing Rules and Regulations states: "The program shall maintain a yearly average minimum pass rate on the licensure examination that does not fall below 10 percentage points of the state average pass rate for first time candidates of accredited vocational nursing schools for the same period. (1) Failure to maintain the required yearly average minimum pass rate for two years or eight consecutive quarters may be cause to place a program on provisional accreditation." The following table shows the variance of the program's pass rates from the state average annual pass rates of first time graduates of accredited vocational nursing programs for the past nine (9) quarters. These data substantiate the program's noncompliance with Section 2530(1) of the Vocational Nursing Rules and Regulations.

18 Quarter Annual Jul-Sep % -41 Oct - Dec % -40 Jan - Mar % 33% -42 Apr - Jun % -41 Jul - Sep % -45 Oct - Dec % -26 Jan - Mar % -43 Apr - Jun % -35 Jul - Sep % 41% -31 Oct - Dec % Historll of Prior Board Actions On May 12, 2006, the Executive Officer approved the Medical Career College to begin a vocational nursing program with an initial class of 30 students on June 19, 2006, only, and approved the program curriculum for 1600 hours, including 630 theory, and 970 clinical hours. On July 10,2007, the Board approved initial full accreditation for the Medical Career College Vocational Nursing Program for the period from July 10, 2007, through July 9, 2011, and issued a certificate accordingly. The Board approved the Medical Career College Vocational Nursing Program to admit a full-time class of 30 students on August 20, 2007, only, to replace students graduating on August 8, The Board also approved the program's request to admit a second full-time class of 30 students on October 1, 2007, only, with a projected graduation date of October 31,2008. On February 27, 2008, the Board approved the Medical Career College Vocational Nursing Program's request to admit 30 students on March 17, 2008, only, with an anticipated graduation date of May 8, On June 4, 2008, the Board approved the Medical Career College Vocational Nursing Program's request to admit 30 students on July 14, 2008, only, with an anticipated graduation date of August 21,

19 On October 8, 2008, the Executive Officer approved the Medical Career College Vocational Nursing Program to replace a full-time morning class of 15 students on December 1, 2008, only, with an anticipated graduation date of January 29, The Executive Officer also approved the Medical Career College Vocational Nursing Program to replace a full-time evening class of 15 students on December 1, 2008, only, with an anticipated gradu~tion date of January 29,2010. On November 13, 2008, the Board representative notified the program director that the pass rates for the Medical Career College Vocational Nursing Program had fallen below 10 percentage points of the state average pass rate for the past four quarters. The Board requested a written plan for improving the program's NCLEX PN pass rates by December 13, The director stated that the program is requiring completion of the ATI tool as part of the program's curriculum review and NCLEX-PN preparation process. The program hired consultants to work with faculty on professional development issues. On March 18, 2009, the Board representative notified the program director that the pass rates for the Medical Career College Vocational Nursing Program have fallen below 10 percentage points of the state average pass rate for the past five (5) quarters. The Board requested a copy of the program's detailed plan for improving the NCLEX-PN pass rates, the date the plan was implemented, and the effectiveness of the employed interventions. This information was due on April 2, The director stated that the program received feedback that students were not following ATI requirements for completion of the Virtual ATI products that were added. The program switched to another review product offered by ATI, and students met with program consultants to review individualized reports regarding their progress. The program re-assigned faculty and hired an assistant director in efforts to strengthen student instruction. On April 21, 2009, the Board representative notified the program director that the pass rates for Medical Career College Vocational Nursing Program have fallen below 10 percentage points of the state average pass rate for the past six quarters. The current annual pass rate is 47%. The Board representative requested documentation verifying that the elements of the program's plan of correction are being carried out. The program was asked to send a full listing of student names, and specific documentation showing how each student met the admissions, screening and selection criteria for admission to the program. The documentation was due by May 21, 2009, but was not received. On July 15, 2009, the director stated "As part of our plan of correction, we replaced Instructors, enhanced our curriculum and were working on creating an Admissions Committee and new policies to be submitted for approval. Once approved, we are 3

20 looking forward to a more successful student population, and once approved for our next class we plan on instituting and having an ongoing evaluation of improvement regarding our newly approved policies." On July 16, 2009, the director sent evidence that all students meet the admissions, screening and selection criteria. On August 19, 2009, the Board notified the program that the pass rates for the Medical Career College Vocational Nursing Program had fallen below 10 percentage points of the state average pass rate for seven (7) consecutive quarters. The consultant requested submission of an analysis of the effects of the program improvement plan. On September 3, 2009, the Executive Officer denied the program's request for admission of a class of 30 students on September 21, 2009, with a projected graduation date of November 30,2010, to replace students that graduated on May 1, This denial is based upon an annual pass rate of 29%. The Executive Officer approved the program's admission of a class of 15 students on September 21, 2009, only, with a projected graduation date of November 30, 2010, only, to replace students that graduated on May 1, The Executive Officer denied the program's request for admission of a class of 30 students on September 21, 2009, with a projected graduation date of November 30, 2010, to replace students that graduated on August 21, This denial is based upon an annual pass rate of 29%, and historical Executive Officer approval of class sizes of 15 students. The Executive Officer approved the program's admission of a class of 15 students on September 21, 2009, only, with a projected graduation date of November 30, 2010, only, to replace students that graduated on August 21,2009. On October 12, 2009, Mary Pat Bonham was approved as director. Enrollment The full-time program is 53 weeks in length. The program requires prior approval for each class admission. The following table represents projected student enrollment based on current and proposed class starts and completions. The table indicates a maximum enrollment of 89 students for the period from December 2008 through September

21 Start CLASS.DATES.... '...'... ~.NROLLMENT DATA>;;V';:;).'~.. '. Complete" 'fp #Students Admitted : #Students Current or Completed, ' :..,: Total ;""~'i Enrolled 12/08 am /08 pm =29 9/09 am 9/09 pm 30 (proposed) 30 (proposed) = =89 Licensing Examination Statistics The following statistics, furnished by Pearson VUE, and published by the National Council of State Boards of Nursing as "Jurisdictional Summary of All First-Time Candidates Educated in Member Board Jurisdiction," for the period January 2008 through December 2009, specify the pass percentage rates for graduates of Medical Career College Vocational Nursing Program on the National Council Licensure Examination for PracticalNocational Nurses (NCLEX-PN ). NCLEX-PN"' Licensure Examination Data Quarterly Statistics Annual Statistics' Program State State # # % Average Average Quarter Quarterly Candidates Passed Passed Annual Annual Pass Rate Pass Rate Pass Rate Jan - Mar % 75% 36% 75% Apr - Jun % 70% 33% 74% Jul - Sep % 74% 33% 74% Oct - Dec 2008 No tests NA NA 73% 29% 73% Jan - Mar % 70% 47% 72% Apr - June % 71% 29% 70% July-Sep % 74% 41% 72% Oct - Dec % 76% 40% 73% The Annual Pass Rate changes every quarter. It is calculated by dividing the number of candidates who passed during the current and previous three-quarters by the number of candidates who tested during the same period. Based on the most recent data available (October to December 2009), the program's average annual pass rate is 40%. The California average annual pass rate for 5

22 graduates from accredited vocational nursing programs who took the NCLEX-PN for the first time during the same period is 73%. The pass rate for the Medical Career College Vocational Nursing Program is 33 percentage points below the state average annual pass rate. Faculty and Facilities Section 2534(d) of the Vocational Nursing Rules and Regulations states: "For supervision of clinical experience, there shall be a maximum of 15 students for each instructor." The total number of Board-approved faculty is 13, including the program director. The director has full-time administrative duties. Of the total faculty, ten (10) are approved to teach in the clinical area. For a maximum enrollment of 89 students, six (6) instructors are needed. Therefore, the number of faculty is adequate for the current and proposed enrollment. Section 2534(b) of the Vocational Nursing Rules and Regulations states: "Schools shall have clinical facilities adequate as to number, type, and variety of patients treated, to provide clinical experience for all students in the areas specified by Section There must be available for student assignment, an adequate daily census of patients to afford a variety of clinical experiences consistent with competency-based objectives and theory being taught." The program's clinical facilities are adequate as to type and variety of patients treated to enable current and proposed students to meet clinical objectives in accordance with Section 2534(b) of the Vocational Nursing Rules and Regulations. This information has been verified by the consultant. Other Considerations Section 2530(1) of the Vocational Nursing Rules and Regulations states, "The program shall maintain a yearly average minimum pass rate on the licensure examination that does not fall below 10 percentage points of the state average pass rate for first time candidates of accredited vocational nursing schools for the same period." Violation: The program has failed to maintain a yearly average minimum pass rate on the licensure examination that does not fall below 10 percentage points of the state average pass rate for first time candidates of accredited vocational nursing schools for the same period, for nine (9) quarters. 6

23 Recommendations: 1. Place the Medical Career College Vocational Nursing Program on provisional accreditation for the two-year period from February 18, 2010, through February 17, 2012, and issue a notice to the program to identify specific areas of noncompliance and requirements for correction as referenced in Section (e) of the California Code of Regulations (see Attachment A Draft). 2. Require the program to show documented progress by submitting a follow-up reports in 10 and 22 months. The report must include a comprehensive analysis of the program, specific actions taken to improve program pass rates, timelines for expected results, and the effectiveness of corrective actions taken to address the following elements: a. Current Student Enrollment. b. Admission Criteria. c. Screening and Selection Criteria. d. Terminal Objectives. e. Curriculum Objectives. f. Instructional Plan. g. Theory and Clinical Objectives for Each Course. h. Lesson Plans for Each Course. I. Textbooks. j. Attendance Policy. k. Remediation Policy. I. Evaluations of Theory and Clinical FaCUlty. m. Evaluations of Theory Presentations. n. Evaluations of Clinical Rotations and Their Correlation to Theory Presentations. o. Evaluation of Student Achievement. 3. Require the program to comply with all accreditation standards in article 4 of the Vocational Nursing Practice Act, commencing at Business and Professions Code section 2880, and article 5 of the Board's regulations, commencing at California Code of Regulations, title 16, section Rationale: The Board has serious concerns relative to the program's non-compliance with regulations relative to pass rate on the NCLEX-PN@ for the last eight (8) quarters. Attachment A - Notice of Change in Accreditation Status Draft. 7

24

25 Agenda Item #14.A.4. Attachment B STATE OF CAI,.IFORNIA BOARD OF VOCATIONAL NURSING & PSYCHIATRIC TECHNICIANS 2535 Capitol Oaks Drive, Suite 205, Sacramento, CA DEPARTMENT OF CONSUMER AFFAIRS Phone (916) Fax (916) I Web March 10,2010 CERTIFIED MAIL Marilyn S. Castillo, M.S., B.S.N., R.N., President Vocational Nursing Program Medical Career College Christy Street Fremont, CA Subject: Notice of Change in Accreditation Status Dear Ms. Castillo: Pursuant to the action of the Board of Vocational Nursing and Psychiatric Technicians (Board) on February 18, 2010, the status of the Medical Career College Vocational Nursing Program has been changed from full accreditation to provisional accreditation for the two - year period from February 18, 2010, through February 17, Please sign and return the enclosed "Acknowledgement of Change in Accreditation Status" form by Friday, March 19, AREAS OF NON-COMPLIANCE [VIOLATION(S)) In accordance with Section (c) of title 16 of the California Code of Regulations, "The Board may place any program on provisional accreditation when that program does not meet all requirements as set forth in this chapter and in Section " Section 2530(1) of title 16 of the California Code of Regulations states: "The program shall maintain a yearly average minimum pass rate on the licensure examination that does not fall below 10 percentage points of the state average pass rate for first time candidates of accredited vocational nursing schools for the same period. (I) Failure to maintain the required yearly average minimum pass rate for two years or eight consecutive quarters may be cause to place a program on provisional accreditation." The program pass rates of the Medical Career College, Fremont, Vocational Nursing Program for the past ten (10) quarters are set forth in the following table.