Adira Nursing and Rehabilitation
3200 State Street · Saginaw, MI · 48602 · 9897991902
92 certified beds For profit - Corporation Chain: Preferred Care
Why this verdict
- Inspection record is far worse than the national median (deficiency count and severity).
- 3 citations involved actual harm to residents.
- Inspection results have improved across recent cycles.
Red flags
Cited under the freedom-from-abuse rule
Cited 1 time under F600 (freedom from abuse/neglect) below the actual-harm level — worth asking about on a tour.
2 actual-harm citations in the most recent cycle
Inspectors found deficiencies that caused real harm to residents, beyond potential-harm paperwork findings.
68% of nursing staff left within a year
High turnover disrupts continuity of care; the national median is 45%.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 2 of 5 Inspections: 2 of 5 Staffing: 2 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 4.03 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.48 | 0.55–0.75 |
| Weekend hours / resident-day | 3.53 | ≈ weekday level |
| Nursing turnover / year | 68% | median 45% |
| Fines (3-yr window) | 1 · $34,100 |
Inspection citations (59 in the current record)
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Potential for harm · D April 20, 2026 · found via complaint
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected April 30, 2026 · Pharmacy Service
-
Actual harm · G January 22, 2026
Provide safe, appropriate pain management for a resident who requires such services.
Corrected February 9, 2026 · Quality of Life and Care
-
Potential for harm · D January 22, 2026
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected February 9, 2026 · Quality of Life and Care
-
Potential for harm · D January 22, 2026
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.
Corrected February 9, 2026 · Pharmacy Service
-
Potential for harm · F January 22, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected February 9, 2026 · Nutrition and Dietary
-
Actual harm · G September 16, 2025 · found via complaint
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected October 1, 2025 · Quality of Life and Care
-
Potential for harm · D March 6, 2025 · found via complaint
Reasonably accommodate the needs and preferences of each resident.
Corrected March 14, 2025 · Resident Rights
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Potential for harm · D March 6, 2025 · found via complaint
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected March 14, 2025 · Quality of Life and Care
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Potential for harm · D March 6, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected March 14, 2025 · Quality of Life and Care
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Potential for harm · D March 6, 2025 · found via complaint
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.
Corrected March 14, 2025 · Nursing and Physician Services
-
Actual harm · G October 31, 2024 · found via complaint
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected December 2, 2024 · Quality of Life and Care
-
Potential for harm · D October 31, 2024
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Corrected December 2, 2024 · Resident Rights
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Potential for harm · E October 31, 2024
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Corrected December 2, 2024 · Resident Rights
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Potential for harm · D October 31, 2024
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected December 2, 2024 · Resident Rights
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Potential for harm · D October 31, 2024
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected December 2, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · E October 31, 2024
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected December 2, 2024 · Resident Assessment and Care Planning
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Potential for harm · E October 31, 2024
Provide activities to meet all resident's needs.
Corrected December 2, 2024 · Quality of Life and Care
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Potential for harm · E October 31, 2024
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected December 2, 2024 · Quality of Life and Care
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Potential for harm · D October 31, 2024
Provide enough food/fluids to maintain a resident's health.
Corrected December 2, 2024 · Quality of Life and Care
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Potential for harm · D October 31, 2024
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Corrected December 2, 2024 · Quality of Life and Care
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Potential for harm · D October 31, 2024
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected December 2, 2024 · Quality of Life and Care
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Potential for harm · D October 31, 2024
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected December 2, 2024 · Pharmacy Service
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Potential for harm · D October 31, 2024
Ensure medication error rates are not 5 percent or greater.
Corrected December 2, 2024 · Pharmacy Service
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Potential for harm · F October 31, 2024
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.
Corrected December 2, 2024 · Pharmacy Service
-
Potential for harm · D October 31, 2024
Provide or obtain dental services for each resident.
Corrected December 2, 2024 · Quality of Life and Care
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| September 16, 2025 | Fine | $34,100 |
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 235250 · certified since December 1, 1975. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.