My experience at San Remo was a mix of the good, the average and the ugly. I went to San Remo after being hospitalized for 12 days for pulmonary problems. I had no strength, was dependent on oxygen, having difficulty swallowing after intubation, and was very shaky on my feet. Goals were to become stronger, wean off of oxygen, learn to swallow properly so that I could return to a normal diet, and to have confidence with balance, stride, etc. First, the good: The therapists (speech, OT, PT) were all very good. Took their time to answer my questions and asked appropriate questions of me. They explained how to do each exercise properly, explained why we were doing what we were doing, how it would help in recovery, and were always encouraging. I found the Speech Therapist to be particularly helpful. they did what they did cheerfully and were very professional. I was on a restricted diet and had just returned to eating at all a few days before going to San Remo. The food at the hospital was really awful and I was hungry! The food at San Remo was surprisingly good, well seasoned, tasty and there were a wide variety of options from which to choose - even with some restrictions on preparation of foods for me! Hooray for their chefs! The average: sfaff had just undergone a reorganization. New people in new roles always requires new learning, extra efforts toward clear communication, and it takes a little time to work out the kinks. I get this. However...it was clear that there were problems in place well before the reorganization became a factor. Nurses seem kind and want to help but are clearly overworked and dealing with inefficient communications within and between departments. Most of them seemed sufficiently skilled but, as others have written, language barriers were a problem. Now, I understand that they speak at least two languages while I only speak one and that these are smart people. I am not denigrating their intelligence at all. If anything, I'm wishing I was bilingual but I'm not and the fact is that if all three members of my family can't understand the nurses, and their english vocabulary is not sufficient enough to explain how to use equipment, then there's a real problem. San Remo would be well-served to send these folks to school to become more proficient in English. I really think all of the nurses wanted to please, to be helpful, and to work with my family as a team but coupled with the systemic communication problems mentioned above, the language barrier became an even larger problem.The bad - when we checked in we provided San Remo with instructions from the pulmonologist regarding meds, diet restrictions, etc. None of this info was distributed to staff. If it wasn't for the fact that my husband and daughter were up there with me a minimum of 8 hours a day, I would not have received the meds I needed. Telling them once was not enough. EVERY TIME there was a shift change, we had to start over with the list of meds, dosage, times to be taken. Had to call the pulmonologist to ask them if we were right in our understanding because San Remo wasn't giving me what we thought they were supposed to. They said yes, were were right and to contact San Remo's Director of Nursing to report problems. As far as I can tell there is/was no one in that position at all. Meds were delivered in pill form with water repeatedly even though all instructions said "patient cannot swallow pills - chop and give with pudding". It was annoying and scary. Sometimes meds not delivered at all but most often they came sooner or later and were eventually straightened out but it took a lot of time and effort on our part to see that it happened. The UGLY: this place is in SERIOUS need of competent, well-trained, administrators with excellent communication skills. I was not officially admitted until 72 hours AFTER I had been in the care of San Remo. The poor little girl doing the admission seemed surprised that we were surprised to be initialling forms stating that we'd received documentation that should have been provided to us within the first 12 business hours (directives to physicians, etc). By the time she started admitting us, we were so frustrated with internal communications problems (see more examples below), we had already told them we wanted me to be released asap and to receive outpatient, rather than in-patient services. She spent a good five minutes telling us how overworked she is. I'm sorry she's overworked but she is forgetting that she's dealing with people who are scared to death, don't understand what's being done to them, and who have received no clear concise plan of care. Plan of care: there is none as far as we can tell. While the staff get together for daily meetings to discuss patients, the patients are never informed of their schedules for the next day. Woken before 7:00 a.m. most days, for blood pressure checks, etc. I would hurry to get dressed hoping that by being ready for the day, I would be take to therapy early and be able to get it over with. No such luck. Get dressed, eat breakfast, sit around and wait and wait and wait, most often until after lunch before someone just shows up unannounced to take you to therapy. Can't nap, can't shower, can't do anything except wait. I did get help from an aide one day to take a shower. Two showers since 12/25. Sure felt good but too little too late, right? Aide stayed with me the entire time, watched me bathe to see what I could do for myself but there to help if help was needed. She shampooed my hair but they have no hair dryer so they said I could just put a towel around my wet hair. Hubby brought hair dryer from home. Not neglect by any means but also not well planned or thought through. It is VERY difficult to get information. It seems that whoever you ask, you should be asking someone else and finding that someone and getting to talk to them takes hours if not a day or two. Like others, we were asked to attend a meeting called the circle of excellence or something. It's supposed to be a meeting between nursing, therapists, family, other staff to set goals and objectives and come up with a plan. Family had to take off from work in order to attend. Showed up at appointed time only to wait and wait and wait. When everyone was finally in the room, no one was in charge. They asked us why we were there!!! We were there looking for help from them, the "experts" to tell us how we could work together to get me well. It was a joke and we left frustrated and they couldn't seem to see why. Only one there with a plan and who was articulate was Speech Therapist. I tried to lift up the good things we'd encountered at the beginning of meeting so that when we brought up concerns we weren't seen as whiners but as soon as we mentioned trouble communicating with nursing staff due to language barriers, we were basically accused of being intolerent. they went right to being defensive, not acknowledging that there might be room for improvement on their end. I've tired myself out just typing all this up. Short story is that they need more staffing all around, especially in administrative/leadership roles. this lack of leadership wears not only on the patients and their families but on staff as well, as evidenced by the truly unhelpful and bad attitude of one person in particular who makes everything far more difficult than need be. in short, be prepared to be your own advocate!