Federal inspection record · CMS data as of October 1, 2026
Royal Middletown Nursing Center
193 Forest Avenue, Middletown, RI · (401) 847-2777
- Certified beds
- 50
- Residents per day
- 47
- Ownership
- For-Profit
- Chain
- Royal Health Group
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- March 31, 1974
1
How this home got 2 stars
The overall rating isn't an average. CMS starts from the inspection rating and nudges it at most two steps. Here is the arithmetic for this home, using CMS's own rules.
-
Health inspections
★★★★★starting point
Everything starts from what state inspectors found on site. This is a ranking against other homes in Rhode Island.
-
Staffing
★★★★★no change
Only a 5-star staffing rating adds a star, and only a 1-star rating removes one. Ratings of 2 to 4 change nothing.
-
Quality measures
★★★★★no change
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
-
Overall
★★★★★2 of 5
Matches the rating CMS publishes on Care Compare.
2
Where it sits among Rhode Island homes
Royal Middletown Nursing Center carries 119.25 inspection points. That is fewer than 31% of Rhode Island's 71 rated homes.
Inspectors' citations earn points by how serious and how widespread they were (the grid below). CMS then ranks every home in Rhode Island: the 10% with the fewest points get 5 stars, the 20% with the most get 1 star, and the middle 70% split evenly into 2, 3 and 4.
- 5★ 0–26 pts
- 4★ 26–54 pts
- 3★ 54–89 pts
- 2★ 89–177.5 pts
- 1★ over 177.5 pts
Bars show every rated home in Rhode Island by its weighted inspection score. CMS recalibrates the cut points monthly but holds a home's rating until its own score changes, so a home can sit just outside today's band.
3
What inspectors found
26 health citations on record since 2024. Each one gets a letter: the row says how badly residents were affected, the column how many.
Immediate jeopardyResidents at risk of serious injury or death
Actual harmA resident was hurt
Potential for harmNo one was hurt, but could have been
Minimal harmPaperwork-level problems
Read the rows, not the total. Most citations nationwide are a D: one problem, nobody hurt. Rows G–I mean a resident was harmed; J–L mean inspectors found residents in immediate danger of serious injury or death.
Small numbers in each cell are the inspection points CMS assigns per citation. Those points are what the state curve above ranks.
Harm and immediate-jeopardy citations (2)
-
H
Provide and implement an infection prevention and control program.
-
G
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Everything else, by area of care
Freedom from Abuse, Neglect, and Exploitation4F
- F
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
- D
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- D
Respond appropriately to all alleged violations.
- D
Respond appropriately to all alleged violations.
Quality of Life and Care4E
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Provide safe, appropriate pain management for a resident who requires such services.
- E
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- E
Provide safe and appropriate respiratory care for a resident when needed.
Pharmacy Service4E
- D
Ensure that residents are free from significant medication errors.
- D
Ensure that residents are free from significant medication errors.
- E
Ensure each resident’s drug regimen must be free from unnecessary drugs.
- D
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Resident Assessment and Care Planning4D
- D
Ensure services provided by the nursing facility meet professional standards of quality.
- D
Ensure services provided by the nursing facility meet professional standards of quality.
- D
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- D
Ensure services provided by the nursing facility meet professional standards of quality.
Infection Control3F
- D
Provide and implement an infection prevention and control program.
- D
Provide and implement an infection prevention and control program.
- F
Provide and implement an infection prevention and control program.
Administration2D
- D
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
- D
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Resident Rights1E
- E
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Nursing and Physician Services1D
- D
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Nutrition and Dietary1F
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspection history
2026-04-30
16 health deficiencies · 0 fire-safety deficiencies
Top issue: Quality of Life and Care (4 deficiencies)
2025-04-02
6 health deficiencies · 3 fire-safety deficiencies
Top issue: Resident Assessment and Care Planning (3 deficiencies)
2024-04-11
4 health deficiencies · 4 fire-safety deficiencies
Top issue: Pharmacy Service (2 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 3 h 11 min of nursing staff time a day, 54 min of it from a registered nurse.
This home
3 h 11 min
Rhode Island average
3 h 47 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 57% of nursing staff and 60% of registered nurses left in the past year.
Reported hours from payroll data the home submits to CMS, divided by its daily resident count. Not adjusted for how sick residents are.
5
Fines and payment denials
$19,884 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2025-11-25 | Fine | $19,884 |
6
Resident outcomes
Quality measures compared with state and national averages. Most come from assessments the home itself reports.
| Measure | This home | State | U.S. |
|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine3.9 pts better | 97.9% | 94.0% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine1.9 pts better | 97.4% | 95.5% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury1.3 pts worse | 4.9% | 3.6% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms18.6 pts better | 0.0% | 18.6% | 13.5% |
| Percentage of long-stay residents who lose too much weight2.6 pts better | 2.5% | 5.1% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication3.9 pts worse | 21.0% | 17.1% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication2.2 pts worse | 24.7% | 22.5% | 15.4% |
| Percentage of long-stay residents who were physically restrainedAbout the same | 0.0% | 0.0% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened16.9 pts worse | 32.7% | 15.8% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased10.3 pts worse | 29.8% | 19.5% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder0.3 pts better | 0.5% | 0.8% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection0.5 pts better | 2.1% | 2.6% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence6 pts worse | 27.4% | 21.4% | 18.3% |
| Percentage of long-stay residents with pressure ulcers1 pts better | 3.0% | 4.0% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine13.7 pts better | 94.0% | 80.3% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit20.7 pts worse | 35.7% | 15.0% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication2 pts better | 0.0% | 2.0% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine15.2 pts better | 92.9% | 77.7% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission8.6 pts better | 16.5% | 25.1% | 23.4% |
·
Who owns and runs it
2 owners and managers reported to CMS. The last column counts how many nursing homes each one is tied to.
Show ownership list
| Name | Role | Share | Homes |
|---|---|---|---|
| Mamary, James | 5% Or Greater Direct Ownership Interest · Individual | 50% | 12 facilities |
| Mamary, James | Operational/Managerial Control · Individual | 0% | 12 facilities |
·
Fire safety
7 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Gas, Vacuum, and Electrical Systems2F
- F
Have generator or other power source capable of supplying service within 10 seconds.
- D
Have proper medical gas storage and administration areas.
Smoke2F
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- E
Install an approved automatic sprinkler system.
Services1F
- F
Have properly installed electrical wiring and gas equipment.
Miscellaneous1F
- F
Have simulated fire drills held at unexpected times.
Egress1F
- F
Install emergency lighting that can last at least 1 1/2 hours.
·
Other homes nearby
-
Grand Islander Center
Middletown, RI · Genesis Healthcare
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 19 min
- Fines
- $93,296
-
John Clarke Senior Living
Middletown, RI
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 30 min
- Fines
- $9,350
-
St Clare Home
Newport, RI
★★★★★- Worst citation, 3 yrs
- E
- Nursing / resident / day
- 4 h 30 min
- Fines
- $0