Lloyd Dean fears the Edmund Hillary Retirement Village in Remuera failed to learn the lessons of his elderly father's injury and death.
The Health and Disability Commissioner's office ruled in 2010, after a long investigation, that the village had failed 82-year-old Gil Dean, who had died in Auckland City Hospital after a fall.
Then in June this year, the commissioner, Anthony Hill, issued a second official criticism of the village - over the case of an elderly woman with multiple illnesses. She had died after a pressure ulcer on her lower back expanded to 3cm wide.
Lloyd Dean said after the second report: "I think that they choose not to learn the lessons. It's not a commodity you're dealing with, it's humans."
But owner Ryman Healthcare dismissed Mr Dean's response to the latest criticism of the village. "I think it's a bit off," said managing director Simon Challies.
"I don't believe there are many parallels."
Gil Dean died in 2007 in the hospital, where he was taken the day after he fell in a bathroom at the village's rest home.
The acting commissioner said in the 2010 report the village had breached the code of patients' rights and its staff had failed to communicate effectively with each other and a GP.
After Lloyd Dean's complaint to the commissioner was sent to the Health Ministry, an audit was conducted which found issues with falls, staffing and other matters.
The audit required the village to introduce a falls risk management plan and other changes. The ministry and Auckland District Health Board subsequently stated they were satisfied with the changes made.
Ryman, in its formal apology to the Dean family, said that after its own investigation of the complaint, it had trained and mentored staff and changed procedures. The village was "fully committed to learning from this experience and raising the level of service we offer".
Mr Hill's report issued in June this year on the later case said the woman was admitted to the village's hospital-level care in 2007 when she was 84.
Read the full report from the Health and Disability Commissioner on the Edmund Hillary Retirement Village here.
During six months in 2010, a pressure area at the base of her back developed into a deep, 3cm-wide ulcer. She was admitted to a public hospital, but her medical condition was so poor she was transferred to palliative care and died soon after.
Mr Hill said the village did not adequately assess the woman's ulcer or monitor her nutritional status. He also criticised two nurses, although he noted they felt overworked and "clinically unsafe".
Mr Challies said, "Those concerns were raised after [the commissioner] investigated the nurses. The Auckland DHB audit shortly after the events confirmed our staffing levels were completely appropriate."
He said Ryman changed its wound management and communication practices to prevent the same type of incident occurring again.
Are you or someone in your family thinking about moving into a rest-home? The Herald has compiled this guide for you to consider before you make your choice.