Cycle 1
Health 2025-04-02 · Fire 2025-04-02
9 health deficiencies
Top issue: Resident Assessment and Care Planning (3 deficiencies)
3 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Middletown, RI
Royal Middletown Nursing Center
3-star overall rating with 3-star inspections with 9 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
193 Forest Avenue, Middletown, RI
(401) 847-2777
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
50
Certified beds
Average residents
44
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Royal Health Group
Operator or chain grouping
Approved since
1974-03-31
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
12 facilities
Chain averages 3 overall / 3 health / 2 staffing / 3 quality stars
Changed ownership
No
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
0.95
Registered nurse staffing · state 0.77 · national 0.68
LPN hours / resident day
0.04
Licensed practical nurse staffing · state 0.51 · national 0.87
Aide hours / resident day
2.00
Nurse aide staffing · state 2.46 · national 2.35
Total nurse hours
3.00
All reported nurse hours · state 3.72 · national 3.89
Licensed hours
1.00
RN + LPN hours · state 1.25 · national 1.54
Weekend hours
2.52
Weekend nurse staffing · state 3.30 · national 3.43
Weekend RN hours
0.63
Weekend registered nurse coverage · state 0.56 · national 0.47
Physical therapist
0.02
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.96
CMS adjusted RN staffing hours
Adjusted total hours
3.03
CMS adjusted total nurse staffing hours
Case-mix index
1.35
Higher values indicate more complex resident acuity
RN turnover
94%
Annual RN turnover · state 38% · national 45%
Total nurse turnover
80%
Annual nurse turnover · state 40% · national 46%
SNF VBP
Value-based purchasing
Program rank
10,725
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
19.34
Composite VBP score used to determine payment impact.
Payment multiplier
0.9821
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0.82
Performance 21.05% · Measure score 0.82 · Achievement 0.82 · This facility did not have sufficient data to calculate a baseline period measure result.
Healthcare-associated infections
6.92
Baseline 6.37% · Performance 5.77% · Measure score 6.92 · Achievement 6.92 · Improvement 3.88
Total nurse turnover
0
Baseline 40.00% · Performance 74.29% · Measure score 0 · Achievement 0 · Improvement 0
Adjusted total nurse staffing
0
Baseline 4.19 hours · Performance 3.14 hours · Measure score 0 · Achievement 0 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 8.67% |
10.72%
2.1 pts better
|
No Different than the National Rate · Eligible stays 69 · Observed rate 2.9% · Lower 95% interval 5.39% |
| Discharge to community | 71% |
50.57%
20.4 pts better
|
Better than the National Rate · Eligible stays 68 · Observed rate 67.65% · Lower 95% interval 59.84% |
| Medicare spending per beneficiary | 0.94 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 97.83% |
95.27%
2.6 pts better
|
Numerator 45 · Denominator 46 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 46 |
| Discharge self-care score | 60.53% |
53.69%
6.8 pts better
|
Numerator 23 · Denominator 38 |
| Discharge mobility score | 50% |
50.94%
0.9 pts worse
|
Numerator 19 · Denominator 38 |
| Pressure ulcers or injuries, new or worsened | 2.17% |
2.29%
0.1 pts better
|
Numerator 1 · Denominator 46 · Adjusted rate 2.24% |
| Healthcare-associated infections requiring hospitalization | 5.77% |
7.12%
1.4 pts better
|
No Different than the National Rate · Eligible stays 41 · Observed rate 0% · Lower 95% interval 2.75% |
| Staff COVID-19 vaccination coverage | 8.33% |
8.2%
0.1 pts better
|
Numerator 3 · Denominator 36 |
| Staff flu vaccination coverage | 28.57% |
42%
13.4 pts worse
|
Numerator 14 · Denominator 49 |
| Discharge function score | 55.26% |
56.45%
1.2 pts worse
|
Numerator 21 · Denominator 38 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | 92.86% |
96.28%
3.4 pts worse
|
Numerator 26 · Denominator 28 |
| Resident COVID-19 vaccinations up to date | 13.64% |
25.2%
11.6 pts worse
|
Numerator 3 · Denominator 22 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 97.7% |
93.2%
4.5 pts better
|
93.4%
4.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 90.9% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 97.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 94.3% |
95.3%
1 pts worse
|
95.5%
1.2 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 94.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 5.3% |
3.6%
1.7 pts worse
|
3.3%
2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.0% · Q2 9.4% · Q3 2.9% · Q4 6.1% · 4Q avg 5.3% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
14.6%
14.6 pts better
|
11.4%
11.4 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 who lose too much weight | 4.5% |
5.3%
0.8 pts better
|
5.4%
0.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.7% · Q2 8.3% · Q3 3.4% · Q4 0.0% · 4Q avg 4.5% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.1% |
16.4%
0.7 pts worse
|
19.6%
2.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 9.7% · Q2 7.1% · Q3 20.0% · Q4 32.1% · 4Q avg 17.1% |
| Percentage of long-stay residents who received an antipsychotic medication | 31.1% |
23.6%
7.5 pts worse
|
16.7%
14.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 28.0% · Q2 36.4% · Q3 28.6% · Q4 31.8% · 4Q avg 31.1% · 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 | 37.2% |
17.0%
20.2 pts worse
|
16.3%
20.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 37.2% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 41.4% |
18.4%
23 pts worse
|
14.9%
26.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 40.0% · Q2 48.1% · Q3 39.3% · Q4 38.5% · 4Q avg 41.4% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
1.0%
1 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 | 2.3% |
2.2%
0.1 pts worse
|
1.7%
0.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.0% · Q2 0.0% · Q3 3.0% · Q4 3.0% · 4Q avg 2.3% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 28.3% |
22.3%
6 pts worse
|
19.8%
8.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 30.8% · Q2 24.5% · Q3 20.6% · Q4 37.7% · 4Q avg 28.3% |
| Percentage of long-stay residents with pressure ulcers | 7.8% |
4.7%
3.1 pts worse
|
5.1%
2.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 15.1% · Q2 4.4% · Q3 7.1% · Q4 4.2% · 4Q avg 7.8% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 87.7% |
77.2%
10.5 pts better
|
81.7%
6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 67.5% · Q2 89.9% · Q3 97.4% · Q4 98.5% · 4Q avg 87.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 31.9% |
15.8%
16.1 pts worse
|
12.0%
19.9 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 31.9% · Observed 28.9% · Expected 10.1% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 2.3% |
1.9%
0.4 pts worse
|
1.6%
0.7 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 4.8% · Q3 2.6% · Q4 0.0% · 4Q avg 2.3% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 81.9% |
78.2%
3.7 pts better
|
79.7%
2.2 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 81.9% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 21.8% |
25.1%
3.3 pts better
|
23.9%
2.1 pts better
|
Short Stay · 20240701-20250630 · Adjusted 21.8% · Observed 18.4% · Expected 20.1% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-04-11 · Fire 2024-04-11
5 health deficiencies
Top issue: Infection Control (1 deficiency)
4 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Cycle 3
Health 2023-02-08 · Fire 2023-02-08
10 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)
2 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-04-02
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2025-05-01
F · Potential for more than minimal harm
2025-04-02
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2025-05-01
F · Potential for more than minimal harm
2025-04-02
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-05-01
F · Potential for more than minimal harm
2024-04-11
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2024-04-30
F · Potential for more than minimal harm
2024-04-11
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-04-30
E · Potential for more than minimal harm
2024-04-11
K351 · Smoke Deficiencies
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2024-04-30
D · Potential for more than minimal harm
2024-04-11
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2024-04-30
F · Potential for more than minimal harm
2023-02-08
K355 · Smoke Deficiencies
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2023-02-21
D · Potential for more than minimal harm
2023-02-08
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-02-21
Inspection history
Recent health citations
D · Potential for more than minimal harm
2026-01-07
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2026-01-16
D · Potential for more than minimal harm
2026-01-07
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2026-01-16
E · Potential for more than minimal harm
2025-12-08
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-12-13
H · Actual harm
2025-11-25
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-12-13
G · Actual harm
2025-11-25
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-12-13
D · Potential for more than minimal harm
2025-04-02
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2025-05-01
D · Potential for more than minimal harm
2025-04-02
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2025-05-01
D · Potential for more than minimal harm
2025-04-02
F726 · Nursing and Physician Services Deficiencies
Health
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.
Corrected 2025-05-01
D · Potential for more than minimal harm
2025-04-02
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2025-05-01
E · Potential for more than minimal harm
2024-11-07
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-11-25
D · Potential for more than minimal harm
2024-10-08
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2024-10-21
F · Potential for more than minimal harm
2024-04-11
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-04-30
F · Potential for more than minimal harm
2024-04-11
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-04-30
E · Potential for more than minimal harm
2024-04-11
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2024-04-30
D · Potential for more than minimal harm
2024-02-29
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2024-03-22
F · Potential for more than minimal harm
2023-02-08
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-03-10
E · Potential for more than minimal harm
2023-02-08
F698 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2023-03-10
E · Potential for more than minimal harm
2023-02-08
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2023-03-10
D · Potential for more than minimal harm
2023-02-08
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2023-03-10
D · Potential for more than minimal harm
2023-02-08
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2023-03-10
D · Potential for more than minimal harm
2023-02-08
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2023-03-10
D · Potential for more than minimal harm
2023-02-08
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2023-03-10
D · Potential for more than minimal harm
2023-02-08
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2023-03-10
D · Potential for more than minimal harm
2023-02-08
F770 · Administration Deficiencies
Health
Provide timely, quality laboratory services/tests to meet the needs of residents.
Corrected 2023-03-10
Penalties and ownership
What sits behind the stars
Ownership
Mamary, James
5% Or Greater Direct Ownership Interest · Individual
Mamary, Jonathan
5% Or Greater Direct Ownership Interest · Individual
Mamary, James
Operational/Managerial Control · Individual
Nearby options
Other facilities in reach
#1
Grand Islander Center
Middletown, RI
2-star overall rating with 2-star inspections with 22 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#2
John Clarke Senior Living
Middletown, RI
5-star overall rating with 4-star inspections with 1 recent health deficiencies
#3
St Clare Home
Newport, RI
3-star overall rating with 4-star inspections with 10 recent health deficiencies
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