Saginaw, MI

Saginaw Senior Care and Rehabilitation Center, LLC

4-star overall rating with 3-star inspections with $68,083 in total fines with 6 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle

4322 Mackinaw Road, Saginaw, MI

(989) 792-8729

Compare this facility

Overall

4 / 5

CMS overall stars

Health inspections

3 / 5

Survey and complaint cycles

Staffing

4 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Nexcare Health Systems

Operator or chain grouping

Approved since

1973-08-31

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

20 facilities

Chain averages 4 overall / 3 health / 4 staffing / 4 quality stars

Changed ownership

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

0.79

Registered nurse staffing · state 0.77 · national 0.68

LPN hours / resident day

0.63

Licensed practical nurse staffing · state 0.88 · national 0.87

Aide hours / resident day

2.30

Nurse aide staffing · state 2.38 · national 2.35

Total nurse hours

3.72

All reported nurse hours · state 4.03 · national 3.89

Licensed hours

1.42

RN + LPN hours · state 1.65 · national 1.54

Weekend hours

3.22

Weekend nurse staffing · state 3.52 · national 3.43

Weekend RN hours

0.46

Weekend registered nurse coverage · state 0.49 · national 0.47

Physical therapist

0.07

Reported PT staffing · state 0.07 · national 0.07

Adjusted RN hours

0.89

CMS adjusted RN staffing hours

Adjusted total hours

4.20

CMS adjusted total nurse staffing hours

Case-mix index

1.21

Higher values indicate more complex resident acuity

RN turnover

53%

Annual RN turnover · state 41% · national 45%

Total nurse turnover

50%

Annual nurse turnover · state 44% · national 46%

SNF VBP

Value-based purchasing

Program rank

9,566

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

23.28

Composite VBP score used to determine payment impact.

Payment multiplier

0.9831

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

2.54

Baseline 20.39% · Performance 20.25% · Measure score 2.54 · Achievement 2.54 · Improvement 0

Healthcare-associated infections

4.43

Baseline 6.44% · Performance 6.51% · Measure score 4.43 · Achievement 4.43 · Improvement 0

Total nurse turnover

Baseline 61.97% · Performance 64.83% · Measure score 0 · Achievement 0 · Improvement 0

Adjusted total nurse staffing

2.34

Baseline 3.92 hours · Performance 3.74 hours · Measure score 2.34 · Achievement 2.34 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	9.96%	10.72% 0.8 pts better	No Different than the National Rate · Eligible stays 58 · Observed rate 8.62% · Lower 95% interval 7.43%
Discharge to community	42.17%	50.57% 8.4 pts worse	No Different than the National Rate · Eligible stays 46 · Observed rate 30.43% · Lower 95% interval 27.79%
Medicare spending per beneficiary	0.67	1.02 0.3 pts better
Drug regimen review with follow-up	89.74%	95.27% 5.5 pts worse	Numerator 35 · Denominator 39
Falls with major injury	2.56%	0.77% 1.8 pts worse	Numerator 1 · Denominator 39
Discharge self-care score	51.61%	53.69% 2.1 pts worse	Numerator 16 · Denominator 31
Discharge mobility score	29.03%	50.94% 21.9 pts worse	Numerator 9 · Denominator 31
Pressure ulcers or injuries, new or worsened	0%	2.29% 2.3 pts better	Numerator 0 · Denominator 39 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization	6.51%	7.12% 0.6 pts better	No Different than the National Rate · Eligible stays 27 · Observed rate 3.7% · Lower 95% interval 3.41%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 105
Staff flu vaccination coverage	30.81%	42% 11.2 pts worse	Numerator 57 · Denominator 185
Discharge function score	54.84%	56.45% 1.6 pts worse	Numerator 17 · Denominator 31
Transfer of health information to provider	95.65%	95.95% 0.3 pts worse	Numerator 22 · Denominator 23
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 4 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	31.82%	25.2% 6.6 pts better	Numerator 7 · Denominator 22

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	2.7	1.7 1 pts worse	1.9 0.8 pts worse	Long Stay · 20240701-20250630 · Adjusted 2.7 · Observed 2.2 · Expected 1.6 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	1.1	1.5 0.4 pts better	1.8 0.7 pts better	Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 0.9 · Expected 1.4 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	98.6%	95.0% 3.6 pts better	93.4% 5.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 98.1% · Q2 98.2% · Q3 100.0% · Q4 98.1% · 4Q avg 98.6%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	100.0%	95.0% 5 pts better	95.5% 4.5 pts better	Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0%
Percentage of long-stay residents experiencing one or more falls with major injury	5.1%	3.1% 2 pts worse	3.3% 1.8 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 7.7% · Q2 7.1% · Q3 5.6% · Q4 0.0% · 4Q avg 5.1% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	5.1%	4.1% 1 pts worse	11.4% 6.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.4% · Q2 6.7% · Q3 6.8% · Q4 0.0% · 4Q avg 5.1%
Percentage of long-stay residents who lose too much weight	3.8%	5.5% 1.7 pts better	5.4% 1.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 4.3% · Q3 6.5% · Q4 0.0% · 4Q avg 3.8%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	17.2%	19.6% 2.4 pts better	19.6% 2.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 13.3% · Q2 19.1% · Q3 19.6% · Q4 16.7% · 4Q avg 17.2%
Percentage of long-stay residents who received an antipsychotic medication	9.6%	16.5% 6.9 pts better	16.7% 7.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 16.7% · Q2 9.4% · Q3 6.2% · Q4 5.7% · 4Q avg 9.6% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.1% 0.1 pts better	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	19.0%	13.9% 5.1 pts worse	16.3% 2.7 pts worse	Long Stay · 2024Q4-2025Q3 · 4Q avg 19.0% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	18.9%	11.7% 7.2 pts worse	14.9% 4 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 40.5% · Q2 14.3% · Q3 10.3% · Q4 8.3% · 4Q avg 18.9% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.0%	0.9% 0.9 pts better	1.0% 1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	0.5%	1.7% 1.2 pts better	1.7% 1.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.8% · Q3 0.0% · Q4 0.0% · 4Q avg 0.5% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	10.1%	20.4% 10.3 pts better	19.8% 9.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 15.7% · Q2 12.4% · Q3 7.6% · Q4 5.4% · 4Q avg 10.1%
Percentage of long-stay residents with pressure ulcers	3.5%	5.6% 2.1 pts better	5.1% 1.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 5.7% · Q2 6.1% · Q3 2.1% · Q4 0.0% · 4Q avg 3.5% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	81.5%	82.8% 1.3 pts worse	81.7% 0.2 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 60.6% · Q2 89.3% · Q3 92.7% · Q4 86.7% · 4Q avg 81.5%
Percentage of short-stay residents who had an outpatient emergency department visit	8.5%	11.5% 3 pts better	12.0% 3.5 pts better	Short Stay · 20240701-20250630 · Adjusted 8.5% · Observed 8.8% · Expected 11.6% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	0.0%	1.3% 1.3 pts better	1.6% 1.6 pts better	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	89.5%	79.5% 10 pts better	79.7% 9.8 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 89.5%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	16.9%	24.2% 7.3 pts better	23.9% 7 pts better	Short Stay · 20240701-20250630 · Adjusted 16.9% · Observed 17.6% · Expected 24.9% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-12-04 · Fire 2025-12-04

6 health deficiencies

Top issue: Pharmacy Service (3 deficiencies)

2 fire-safety deficiencies

Top issue: Egress (1 deficiency)

Cycle 2 Health 2024-10-09 · Fire 2024-10-09

16 health deficiencies

Top issue: Quality of Life and Care (9 deficiencies)

3 fire-safety deficiencies

Top issue: Emergency Preparedness (1 deficiency)

Cycle 3 Health 2023-10-19 · Fire 2023-10-19

7 health deficiencies

Top issue: Quality of Life and Care (3 deficiencies)

6 fire-safety deficiencies

Top issue: Miscellaneous (2 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-12-04

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2025-12-17

E · Potential for more than minimal harm 2025-12-04

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2025-12-17

F · Potential for more than minimal harm 2024-10-09

E13 · Emergency Preparedness Deficiencies

Fire Safety

Develop Emergency Preparedness policies and procedures.

Corrected 2024-11-05

F · Potential for more than minimal harm 2024-10-09

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2024-11-05

F · Potential for more than minimal harm 2024-10-09

K916 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have a battery powered remote alarm panel in a location accessible by operating personnel.

Corrected 2024-11-05

F · Potential for more than minimal harm 2023-10-19

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-11-14

E · Potential for more than minimal harm 2023-10-19

K293 · Egress Deficiencies

Fire Safety

Have properly located and lighted "Exit" signs.

Corrected 2023-11-14

E · Potential for more than minimal harm 2023-10-19

K321 · Smoke Deficiencies

Fire Safety

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Corrected 2023-11-14

E · Potential for more than minimal harm 2023-10-19

K753 · Miscellaneous Deficiencies

Fire Safety

Have restrictions on the use of highly flammable decorations.

Corrected 2023-11-14

E · Potential for more than minimal harm 2023-10-19

K781 · Miscellaneous Deficiencies

Fire Safety

Have restrictions on the use of portable space heaters.

Corrected 2023-11-14

E · Potential for more than minimal harm 2023-10-19

K919 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Meet requirements for the use of electrical equipment.

Corrected 2023-11-14

Inspection history

Recent health citations

E · Potential for more than minimal harm 2025-12-04

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2025-12-17

E · Potential for more than minimal harm 2025-12-04

F761 · Pharmacy Service Deficiencies

Health

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 2025-12-17

E · Potential for more than minimal harm 2025-12-04

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-12-17

D · Potential for more than minimal harm 2025-12-04

F550 · Resident Rights Deficiencies

Health

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Corrected 2025-12-17

D · Potential for more than minimal harm 2025-12-04

F755 · Pharmacy Service Deficiencies

Health

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Corrected 2025-12-17

D · Potential for more than minimal harm 2025-12-04

F759 · Pharmacy Service Deficiencies

Health

Ensure medication error rates are not 5 percent or greater.

Corrected 2025-12-17

D · Potential for more than minimal harm 2025-02-06

F678 · Quality of Life and Care Deficiencies

Health

Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

Corrected 2025-02-06

G · Actual harm 2024-10-09

F686 · Quality of Life and Care Deficiencies

Health

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Corrected 2024-11-07

E · Potential for more than minimal harm 2024-10-09

F550 · Resident Rights Deficiencies

Health

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Corrected 2024-11-07