45.8/100
Below average
193 Forest Avenue, Middletown, RI 02842
These are findings in the public CMS record for this home. They are not our opinion — each one comes straight from a federal inspection or enforcement file.
2 citation(s) involving actual harm or immediate jeopardy
Inspectors found violations at scope/severity G or above, meaning residents were harmed or placed in immediate jeopardy.
$30,590 in federal fines
CMS has fined this facility across 1 penalty action(s).
Nursing staff turnover of 63%
High turnover means residents rarely see the same caregiver twice. The national average is about 50%.
Every point is shown. Nothing is weighted behind the scenes — the full formula is on How we grade.
Citations from state health inspections over the last three surveys, weighted by how much harm CMS says they caused.
Nursing hours per resident per day, adjusted for how sick the residents are, plus RN cover and weekend consistency.
How much of the nursing team leaves in a year. High turnover means a resident rarely sees the same face twice.
The CMS quality-measure rating, built from resident outcomes like falls, pressure ulcers, infections and antipsychotic use.
Fines and payment denials CMS has imposed. A denial of payment means CMS stopped paying for new admissions.
Hours of nursing care each resident receives per day. The marker on each bar is the national average.
RNs are the licence level most likely to catch a resident deteriorating.
The shift most families visit, and the one thinned first.
The share of nursing staff who left over the last year.
Last standard health inspection: April 30, 2026 (3 months ago).
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
No actual harm, potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
No actual harm, potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
No actual harm, potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
No actual harm, potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
No actual harm, potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
No actual harm, potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
No actual harm, potential for more than minimal harm
Administration Deficiencies
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.
No actual harm, potential for more than minimal harm
Part of ROYAL HEALTH GROUP, which operates 12 homes. Staffing budgets are usually set at chain level, not in the building.
| Owner | Type | Role | Since |
|---|---|---|---|
| MAMARY, JAMES | Individual | OPERATIONAL/MANAGERIAL CONTROL | — |
| MAMARY, JAMES | Individual | 5% OR GREATER DIRECT OWNERSHIP INTEREST | — |
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Royal Middletown Nursing Center holds an ElderGrade of D (45.8 out of 100), which we describe as "below average". The grade combines its inspection citations, nurse staffing levels, staff turnover, resident outcomes and enforcement history from the federal CMS record.
Residents receive an average of 3.21 nursing hours per day across all nursing staff, against a national average of 3.86 hours.
Yes. 2 of the 26 citations on record were scored at scope and severity G or above, meaning inspectors found actual harm to a resident or immediate jeopardy to resident safety.
Yes, Royal Middletown Nursing Center is certified to accept Medicaid, which is the programme that pays for long-term custodial care once a resident meets their state's income and asset limits.