Using the suggested elements to write a review of Villa Rancho Bernardo is helping me to be objective.
The FIRST thing we should have been wise enough to ask about was, "Did the facility have a Family Support Group?". It does not, and attempts by myself and others to establish one were firmly discouraged. We learned that VRB does not want family members to get together and compare notes, experiences and be supportive of one another. (There is a Resident's Support Meeting. We learned from several residents that although they have an opportunity to voice their concerns, "nothing is ever done" about them and participants consider them a "farce".)
The SECOND thing we should have investigated was whether or not the facility was a "For Profit Facility" and if it was part of a large corporation that owns more than one business. VRB is just such a for profit facility and part of a group of more than a dozen like businesses. (After being sued, one of their facilities was closed. The amount facilities can be sued is limited by the state - as in the case of the VRB resident who choked to death.) Because of the owners/managers focus on profit, staff and resources are stretched thin. Comparing staff ratios with other facilities in CA is misleading. We've learned that the staff is overworked and it was unable to properly care for our loved one who was unable to care for herself. She was left to sit in a wet diaper or wet bed for hours until we complained. Although there was a pitcher of water at her bedside, she was unable to pour it for herself. The staff considered the few spoonsful of water she had with her medications to have provided her with a drink of water. They do not seem to know the meaning of the word "hydration".
The THIRD important thing to know is that after the first three months, Medicare and our mom's private insurance stopped and she was placed on Medi-Cal which meant that the facility received a greatly reduced amount of money for mom. We were repeatedly encouraged to take her to another facility - we felt it was because we were vigilant about how mom was being cared for. (When one is no longer eligible for that first three months worth of full coverage, other facilities don't want to take a person in. They want - and need - all the money they can get.)
The FOURTH thing we should have known is that once a person is put into a bed/room, they cannot be forced to move to another. (We learned this fact from a representative from the CA state's Ombudsman - months after our mom was moved from the "Showcase" room she had been originally assigned to for the first three months on the main floor - and her FULL insurance coverage ran out.)
The FIFTH thing we learned was the "Contracted" staff members are much better paid for their efforts than regular staff. This is probably why the Contracted Therapists were professional in treating mom vs. the regular staff member who provided physical therapy for her. He was assigned to put mom into a "Standing Frame" to assist her and help keep her upright as she bore weight on her legs. We saw that her ankles were crossed and only her toes were touching the floor. When we reported this she never again received this therapy when we were present. There was no oversight - whether it was that PT was being done correctly or that at mealtime residents were engaged in conversation rather than ignored as staff interacted amongst themselves. In the more than year our mom was at VRB of the more than forty+ staff members assigned to her there were perhaps six or so who considered what they were doing a vocation and not just a time card to be punched.
The SIXTH thing we learned was to DOCUMENT all of our observations - in both writing and photographs. Doing both of these things helped mom get better care. Involving both the Ombudsman and State Licensing also let the "Business" know that we expected mom to receive the care promised in the advertisements. It did not make us popular but it did keep people on their toes and got mom better care.
The SEVENTH thing we learned is that the staff - including the Senior Staff - in particular Nursing - will lie either outright or more likely by omission to protect the institution. For example when we asked if mom had been treated by a Medi-Cal physician vs. the private one we regularly took her to when we learned by our own observation she had received an injury, we were lied to and told, "No.". Only after we took mom to her private physician did she receive treatment when we learn that she had contracted a virulent infection that complicated her health and which contributed to her death. The fact that several written notifications were posted around mom's bed to ALWAYS keep her head elevated were ignored and, she died gasping for breath in our presence shorty after we found her so flat in her bed, we initially thought the bed was empty. Hours of ignoring her position were never recorded in her record. The representative from State Licensing told us there was "no documentation" of the fact in her record and after-all "She was old." - as if it didn't matter that she died because of staff negligence.
FINALLY, it should have been an indicator of things to come when the doctor at the hospital (after mom had the stroke that resulted in her being transferred to VRB) did not want her to be fed. Then within the first few days of her being at VRB - the doctor who came highly recommended by her personal physician - asked me, "Why do you want to keep her alive? Does it make you feel good?"
REMEBER - you are the customer - "BUYER BEWARE!" Your involvement is critical. It will not make things perfect but it is necessary if you care about the care being given.