Royal Middletown Nursing Center

Name: Royal Middletown Nursing Center
Address: 193 Forest Avenue, Middletown, RI, 02842, US
Telephone: 4018472777

193 Forest Avenue, Middletown, RI 02842 · Newport County · 50 certified beds · avg 45 residents/day · certified since Mar 31, 1974

Part of chain: ROYAL HEALTH GROUP (12 facilities, chain avg rating 3.1★)

2/5

Health inspection rating (on-site)

Serious findings on record

$30,590

Fines, last 3 years

3.21

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 2/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

Most serious findings (actual harm or immediate jeopardy)

▲ Actual harm, repeated · Nov 25, 2025 · F-0880 · triggered by a complaint

The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.

Why it matters: Weak infection control lets illnesses like flu, COVID-19, and drug-resistant infections spread quickly among vulnerable residents.

Severity (H): Multiple residents were actually harmed by the same failure — a pattern of real harm, not an isolated incident.

Corrected: Dec 13, 2025 (Deficient, Provider has date of correction)

▲ Actual harm, one-off · Nov 25, 2025 · F-0684 · triggered by a complaint

The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.

Why it matters: Care that strays from doctor's orders or ignores the resident's wishes can lead to declining health and avoidable harm.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

Corrected: Dec 13, 2025 (Deficient, Provider has date of correction)

All citations in the current public record (26)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

Date	Severity	What the facility was cited for
Apr 30, 2026	F · Potential for harm, facility-wide	The facility hired someone with an official finding of abuse, neglect, exploitation, or theft against them. Facilities are not allowed to employ people with such findings. · from a complaint
Apr 30, 2026	E · Potential for harm, repeated	The facility did not treat residents with respect and dignity, or did not let them keep and use their own personal belongings.
Apr 30, 2026	D · Potential for harm, one-off	The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint
Apr 30, 2026	D · Potential for harm, one-off	The facility did not respond appropriately to alleged violations, such as reports of abuse, neglect, or mistreatment. Facilities must investigate every allegation and protect residents while they do.
Apr 30, 2026	D · Potential for harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Apr 30, 2026	D · Potential for harm, one-off	The facility did not provide safe and appropriate pain management for a resident who needed it.
Apr 30, 2026	D · Potential for harm, one-off	The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication.
Apr 30, 2026	D · Potential for harm, one-off	The facility did not arrange hospice services for a resident who needed them, or help the resident move to a facility that could arrange hospice. Hospice provides comfort-focused care for people nearing the end of life.
Apr 30, 2026	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Feb 19, 2026	D · Potential for harm, one-off	The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication. · from a complaint
Feb 19, 2026	D · Potential for harm, one-off	The facility did not arrange hospice services for a resident who needed them, or help the resident move to a facility that could arrange hospice. Hospice provides comfort-focused care for people nearing the end of life. · from a complaint
Jan 7, 2026	D · Potential for harm, one-off	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. · from a complaint
Jan 7, 2026	D · Potential for harm, one-off	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
Dec 8, 2025	E · Potential for harm, repeated	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint
Nov 25, 2025	▲ H · Actual harm, repeated	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
Nov 25, 2025	▲ G · Actual harm, one-off	The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint
Apr 2, 2025	D · Potential for harm, one-off	The facility did not respond appropriately to alleged violations, such as reports of abuse, neglect, or mistreatment. Facilities must investigate every allegation and protect residents while they do. · from a complaint
Apr 2, 2025	D · Potential for harm, one-off	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow.
Apr 2, 2025	D · Potential for harm, one-off	The facility did not make sure its nurses and nurse aides had the skills and training needed to properly care for every resident.
Apr 2, 2025	D · Potential for harm, one-off	The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards.
Nov 7, 2024	E · Potential for harm, repeated	The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it. · from a complaint
Oct 8, 2024	D · Potential for harm, one-off	The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. · from a complaint
Apr 11, 2024	F · Potential for harm, facility-wide	The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. · from a complaint
Apr 11, 2024	F · Potential for harm, facility-wide	The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
Apr 11, 2024	E · Potential for harm, repeated	The facility did not keep residents' medications free from unnecessary drugs. Residents should only take medicines they truly need, at the right dose, for a clear reason. · from a complaint
Feb 29, 2024	D · Potential for harm, one-off	The facility did not keep residents' medications free from unnecessary drugs. Residents should only take medicines they truly need, at the right dose, for a clear reason. · from a complaint

Inspection trend by year

Citations from standard inspections increased between the last two inspection cycles (3 → 7).

Year	Citations	Serious (G–L)	Worst severity that year
2024	6	0	F
2025	7	2	H ▲
2026	13	0	F

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

1 fine totaling $30,590.

Date	Type	Amount / length
Nov 25, 2025	Fine	$30,590

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	Rhode Island avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	3.21	3.88	3.95	bottom 16% in Rhode Island; bottom 22% in the U.S.
Registered Nurse hours	0.92	0.80	0.69	top 32% in Rhode Island; top 20% in the U.S.
Weekend total nurse staffing	2.95	3.48	3.50	bottom 23% in Rhode Island; bottom 28% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.66	0.55	0.48	top 30% in Rhode Island; top 18% in the U.S.
Total nursing staff turnover (%)	62.5	40.6	45.8	bottom 6% in Rhode Island; bottom 13% in the U.S.
RN turnover (%)	69.2	37.9	42.9	bottom 5% in Rhode Island; bottom 12% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.21, RN 0.92, weekend 2.94. Staffing rating: 2/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 2/5 · long-stay residents: 1/5 · short-stay residents: 3/5

Who owns this facility

For profit - Partnership

Owner / manager	Type	Role	Stake	Since
Mamary, James	Individual	5% or Greater Direct Ownership Interest	50%	01/14/2016
Mamary, James	Individual	Operational/Managerial Control	NOT APPLICABLE	08/19/2016

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
"How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
"How do you screen job applicants for past findings of abuse, neglect, or theft before hiring?"
"How do you train staff to treat residents with dignity, and how do you protect residents' personal belongings?"
"Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
"If someone reports suspected abuse or neglect here, what happens in the first 24 hours?"
"How do you assess and manage residents' pain, especially for those who have trouble communicating?"
"What systems do you use to prevent medication errors, and what happens when one occurs?"
"What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
"Can I see the results and plan of correction from your most recent state inspection?"

Nearby facilities (within 20 miles)

Facility	Distance	City	Overall	Inspection
Grand Islander Center	1.5 mi	Middletown, RI	★★☆☆☆	2/5
John Clarke Senior Living	1.6 mi	Middletown, RI	★★☆☆☆	2/5
St Clare Home	3.4 mi	Newport, RI	★★★★☆	5/5
Adviniacare Newport, LLC	3.7 mi	Newport, RI	★★☆☆☆	2/5
Village House Nursing & Rehabilitation Center	4.3 mi	Newport, RI	★★★★☆	4/5
Bayview Rehabilitation and Healthcare Center	10.4 mi	North Kingstown, RI	★★☆☆☆	2/5
Silver Creek Rehab and Healthcare Center	10.5 mi	Bristol, RI	★★☆☆☆	2/5
South County Eden Operations LLC DBA Lakeside Nurs	10.5 mi	North Kingstown, RI	★★★★☆	4/5
The Dawn Hill Home for Rehab and Healthcare	11.1 mi	Bristol, RI	★★★★☆	4/5
Roberts Health Centre INC	11.1 mi	North Kingstown, RI	★★★★★	4/5

Compare this facility with the 3 closest →

All facilities in Middletown →

Facility data as of CMS processing date 2026-08-01. CCN 415040.

The Care File

Visit checklist — Royal Middletown Nursing Center

193 Forest Avenue, Middletown, RI 02842 · 4018472777

Health inspection rating 2/5 · CMS overall 2/5· Fines (3y): $30,590

Most serious findings on record:

▲ Nov 25, 2025 (F-0880, Actual harm, repeated): The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
▲ Nov 25, 2025 (F-0684, Actual harm, one-off): The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.

Questions for the administrator:

☐ "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
☐ "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
☐ "How do you screen job applicants for past findings of abuse, neglect, or theft before hiring?"
☐ "How do you train staff to treat residents with dignity, and how do you protect residents' personal belongings?"
☐ "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
☐ "If someone reports suspected abuse or neglect here, what happens in the first 24 hours?"
☐ "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
☐ "What systems do you use to prevent medication errors, and what happens when one occurs?"
☐ "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
☐ "Can I see the results and plan of correction from your most recent state inspection?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 415040 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)