San Rafael Nursing and Rehabilitation Center
Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 30 Google reviews

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Quality Concerns Identified
Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.
- Low overall rating (1/5 stars)
- Low staffing rating (2/5 stars)
- Above-median deficiencies (24 vs median 8.0)
Bottom 25% in Texas · Critically understaffed (RN) · Worst in BOOKER HOSPITAL DISTRICT chain · $88,828 in fines
What this means for your family
This facility offers an excellent rehabilitation program and a dedicated event planner for resident engagement. However, families must be extremely vigilant regarding facility cleanliness and weekend staffing, as multiple reports indicate significant lapses in hygiene and responsiveness during off-hours.
Google Reviews
Google Reviews
30 reviews on Google“Families considering San Rafael should weigh the highly praised rehabilitation and nursing teams against serious allegations of neglect and poor facility maintenance. While many reviewers highlight compassionate care and excellent physical therapy, several others report severe issues including theft, hygiene concerns, and inadequate staffing on weekends.”
Quality Themes
Tap a score for detailsStrengths
- Compassionate rehabilitation and therapy teams
- Warm and welcoming nursing staff
- Engaging resident activities and events
- Effective admission coordination
Concerns
- Inadequate staffing levels, particularly on weekends (mentioned by 2 reviewers)
- Poor facility cleanliness and maintenance (mold, pests, rundown bathrooms) (mentioned by 3 reviewers)
- Communication difficulties with administration and staff (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 32 analyzed
How They Respond to Reviews
The owner provides personalized responses to positive reviews, often naming specific staff members mentioned by the reviewer. For negative reviews, the owner uses a consistent strategy of citing 'new ownership and management' as a solution to past or current issues.
Questions for Your Tour
- 1We've heard wonderful things about your rehabilitation and therapy teams; could you tell us more about how they work with residents to regain their strength?
- 2What specific steps are being taken to ensure the facility is kept clean, well-maintained, and comfortable for all residents?
- 3How do you ensure that communication remains clear and consistent between the nursing staff and family members, especially during the weekends?
- 4Could you describe what a typical day looks like regarding resident activities and social events to keep everyone engaged?
- 5What is the protocol for handling medical emergencies or urgent care needs during the night or on weekends when fewer staff members are present?
- 6We noticed you are very active in responding to feedback; how does the administration use resident and family suggestions to improve dining and food services?
Personalized based on this facility's data
Key Review Excerpts
“The rehab team work diligently together to help each resident improve their quality of life!”
“I can sleep well knowing my mother is in good hands and well taken care of.”
“Some of the employees are good but you also have some not do good. I wish more people would go see relative on weekends. They don't have enough staff.”
Staffing
Staffing Hours
per resident/day · Medicare 2026Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.
Quality Measures
Quality Measures
Resident outcomes compared with national, state, and local averages · 17 measures
4
measures
7
measures
6
measures
Residents vaccinated for the flu
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents on antipsychotic medication
Residents whose bladder or bowel control got worse
Residents on anti-anxiety or sleep medication
Residents needing more daily help over time
Short-stay residents vaccinated for pneumonia
Short-stay residents vaccinated for the flu
Short-stay residents newly given antipsychotics
US average from Medicare published data
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
This facility shows a concerning pattern of persistent safety and care issues, with families filing 40 complaints that triggered inspections. The most recurring problems involve accident prevention and safety hazards, medication management errors, and maintaining proper medical records. While the facility corrects deficiencies when cited, the same issues repeatedly surface across multiple surveys, particularly safety hazards that have appeared in complaint-triggered inspections from 2023 through 2025, suggesting ongoing challenges with sustained improvements.
Dec 1, 2025Complaint4
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Nursing and Physician Services Deficiencies
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Oct 27, 2025Complaint4
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Aug 21, 2025Complaint4
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Mar 6, 2025Routine19
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Environmental Deficiencies
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Resident Rights Deficiencies
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Nutrition and Dietary Deficiencies
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Mar 6, 2025Complaint1
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Feb 6, 2025Complaint3
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from the wrongful use of the resident's belongings or money.
Federal Penalties
Fine
Oct 27, 2025
$26,685
Fine
Aug 21, 2025
$24,845
Fine
Dec 14, 2023
$10,036
Fine
Jul 17, 2023
$27,262
Ownership & Operations
Who Operates This Facility
Booker Hospital District
for profit
SAN RAFAEL LTC INC
RONALD C BYERS
Ownership & Management
Owners
Booker Hospital District
Owner · Organization
Key personnel
Contact
Get in Touch
Contact this facility directly and verify the details that matter most to your family.
References & Resources
Medicare Care Compare
Official Medicare quality ratings, inspections & staffing data
Google Maps
Photos, directions & neighborhood info
Google Reviews
30 reviews from families & visitors
Medicare data downloads
Original nursing home datasets
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