South Carolina caregiver training: eight topics before client contact, then every year

Basic first aid, and CPR

"Basic first aid" is topic A, before client contact and at least annually, Class I (R.60-122 §404.A). The rule does not mention CPR.

The annual repeat applies "unless otherwise specified by certificate" (§404). The rule does not explain those words. By our reading, when a caregiver holds a current first aid certificate that states how long it is valid, the topic is renewed when the certificate expires rather than every year. That reading is on our list of questions for DPH. A recognized first aid course with a certificate, plus CPR, is a sensible choice; CareRulebook’s manual lists both as Recommended practice, labelled as going beyond the rule.

Who gives the training

• Appropriate resources. Training is provided by appropriate resources, for example licensed, registered or certified persons, books or electronic media. The rule names no approved trainer or course. (R.60-122 §404)
• The caregiver’s own training. Caregivers "receive or independently obtain" the training they need (§404). The rule does not say what evidence of outside training you must accept. CareRulebook’s manual counts it when there is a signed and dated record, it covers the topic, and it is less than 12 months old or the certificate is current.
• Online courses. "A signature for the individual providing the training may be omitted for computer-based training." (§404)
• No nurse needed. R.60-122 does not require a nurse, for training or anything else; a nurse is named only as one of the people who may review drug tests and self-assessments (§402.B, §406.A).

Before client contact, and every year

The rule ties the first round to "client contact", not to the hire date, so a new caregiver can do paperwork and training before their first visit. By our reading, going along on another caregiver’s visit to watch is client contact, so it comes after the training; that point is on our list of questions for DPH.

"At least annually" is not defined. CareRulebook’s manual reads it as no more than 12 months between trainings in any topic, and keeps a training calendar so no caregiver goes past their date. A caregiver whose yearly training is overdue does not work with clients until it is done: that is the manual’s rule, chosen because §404 is Class I (§404).

Signed training records

"Documentation of all in-service training shall be signed and dated by both the individual providing the training and the individual receiving the training." (R.60-122 §404). Training is also part of the staff record: "The provider shall maintain accurate information on all staff members including, but not limited to, current address, phone number, training, all drug test results, criminal background checks, and self-assessments." (§403).

The rule speaks of "in-service training" records. By our reading the signature duty also covers the training before client contact, so CareRulebook’s manual records every session the same way: topic, date, method, trainer and length, signed by both. Inspections are unannounced (§202; how DPH inspects), so keep the records filed in each staff record (Staff records, Policy 2.4).

The health self-assessment, not TB tests (Class I)

• Before first contact. "All staff members and caregivers who have contact with clients shall complete a self-assessment prior to initial client contact." "The self-assessment shall be reviewed and signed by a nurse, the administrator, or human resources/hiring personnel prior to the staff member or caregiver’s initial client contact." (R.60-122 §406.A)
• What it discloses. At a minimum the self-assessment discloses communicable diseases such as influenza, measles, mumps, chicken pox, strep throat, tuberculosis, HIV/AIDS and hepatitis. (§406.B). We found no DPH form for it, so CareRulebook’s manual includes its own.
• A reporting and exclusion policy. You write policies for caregivers to report their health to the administrator as it relates to communicable disease while providing care. "The policies and procedures shall further include provisions for excluding and/or restricting caregivers with communicable diseases or symptoms of such diseases." (§406.C). The rule gives no exclusion periods; CareRulebook’s manual sets its own table, for example 48 hours after the last episode of vomiting or diarrhea, labelled as the manual’s procedure.

TB. Before May 22, 2026, staff with client contact needed a health assessment within 12 months before first client contact, including tuberculosis screening, and every provider ran an annual tuberculosis risk assessment. (R.60-122, 2014 text §400). The 2026 rule has neither. DPH’s in-home care page (updated November 10, 2025) still links the TB Risk Assessment (Short Form) and the 2015 memo, although the 2026 rule no longer requires TB screening. (DPH In-Home Care Providers page). Medicaid contracts may still ask for a TB test (below).

The self-assessment holds health information, so by our reading it should be kept in a closed section of the staff record that only the reviewer and the administrator see; the rule does not say this. CareRulebook’s manual does it in Policy 2.8.

Caregiver minimum qualifications

Section 405 is marked (II); its registry and conviction standards are (I) (R.60-122 §405). A caregiver must:

1. "be able to read, write, and communicate effectively with client and supervisor" (§405.A);
2. be capable of completing assigned job duties (§405.B);
3. "be capable of providing care as provided in the care services plan with minimal supervision, if applicable" (§405.C);
4. "have a valid driver’s license and proof of insurance if transportation is a part of the caregiver’s duties"; you verify the official driving record, and "A copy of the driving record must be maintained in the caregiver’s file" (§405.D);
5. "be at least eighteen (18) years of age, as evidenced by a government-issued identification card or other valid documentation" (§405.E);
6. have no adverse registry findings and no barred convictions (§405.F-G): see caregiver background checks.

The rule sets no supervision schedule. CareRulebook’s manual includes a supervision policy (Policy 2.7) on who supervises and when caregivers call; supervisory visits or check-ins are offered as Recommended practice, labelled as beyond the rule.

Already licensed: your current caregivers

The 2026 rule applies to every provider from May 22, 2026 and has no transition period (R.60-122 §101). By our reading that means:

• Training. Any current caregiver without a signed record in the last 12 months for a topic that applies to them completes it as soon as it can be arranged. Prevention of abuse, neglect and exploitation is new as a separate topic, so every current caregiver gets it.
• Self-assessments. §406.A ties the self-assessment to "initial client contact", which current caregivers have already had. Having each one complete a self-assessment now still gives you the staff record §403 asks for (§403).
• Old TB records stay in the staff files as part of the record; you do not need to repeat TB screening for the license.

DPH has not published guidance on how it will inspect existing agencies against the new rule.

What the DPH license does not require

• Set hours, a curriculum or a certification. Topics only (R.60-122 §404).
• CPR. Basic first aid only (§404.A).
• A TB test or TB risk assessment. Replaced by the self-assessment (2014 text §400; §406).
• Medication training. Dropped with medication assistance (2014 text §300.D.2).
• A nurse to train or supervise. The rule names a nurse only as one possible reviewer of drug tests and self-assessments (§402.B, §406.A)

Not settled yet

Points the rule leaves open, each on our list of questions for DPH. CareRulebook’s manual states its own reading until DPH answers:

• Whether a certificate’s own validity period (for example a two-year first aid certificate) replaces the yearly repeat.
• Whether the signature duty for "in-service training" covers the training before client contact, and whether shadowing another caregiver’s visit is client contact.
• What training obtained elsewhere DPH accepts.
• Whether DPH has a self-assessment form, and whether it still expects any TB screening (DPH’s page still links a TB form).