Royal Middletown Nursing Center, Middletown, RI

The Essentials

Summary

Across 10 inspections from February 2024 to April 2026, state surveyors documented 26 findings at Royal Middletown Nursing Center; 26 have a recorded correction; CMS lists 1 enforcement action in the window.

Inspections: 10; 2024–2026, standard and complaint
Findings: 26; Deficiencies cited by state inspectors
Corrected: 26; Of 26 findings, with a recorded correction date
Penalties: 1; 1 fine; payment not published

Findings by Year

Findings
Of which, actual harm (level G or above)

* Partial year, through October 1, 2026.

Findings by year
Year	Inspections	Findings	Of which, actual harm (level G or above)
2024	4	6	0
2025	3	7	2
2026	3	13	0

What the Record Shows

26 of 26 findings have a recorded correction date.
CMS lists 1 enforcement action in the window: 1 fine of $19,884, its payment not published.
10 visits in this window included a complaint investigation. CMS publishes what a complaint investigation cited, not what the complaint alleged.
The latest standard inspection, April 30, 2026, recorded 9 findings (most serious: Level F).

What to Ask About

Infection Control, Cited in Four Inspections
Professional Standards, Cited in Three Inspections
Quality of Care, Cited in Three Inspections
Investigating Alleged Violations, Cited in Two Inspections
Citation F757, Cited in Two Inspections
Significant Medication Errors, Cited in Two Inspections
Citation F849, Cited in Two Inspections

Report at a Glance

Facility: Royal Middletown Nursing Center
Address: 193 Forest Avenue, Middletown, RI 02842
CMS Certification Number: 415040
Provider Type: Skilled nursing facility and nursing facility
Certified Beds: 50
Ownership: For profit - Partnership
Record Window: February 29, 2024 to October 1, 2026

Chronology

Inspection History

Every inspection in the record window, newest first. A finding is a deficiency an inspector cited. CMS publishes what a complaint investigation cited, not what the complaint alleged.

Apr 302026
Standard health inspection
9 findings
The same visit included a complaint investigation.
- F606Not hire anyone with a finding of abuse, neglect, exploitation, or theft.Level FNo actual harm, potential for moreCorrected May 15, 2026
- F557Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.Level ENo actual harm, potential for moreCorrected May 15, 2026
- F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Level DNo actual harm, potential for moreCorrected May 15, 2026
- F610Respond appropriately to all alleged violations.Level DNo actual harm, potential for moreCorrected May 15, 2026
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level DNo actual harm, potential for moreCorrected May 15, 2026
- F697Provide safe, appropriate pain management for a resident who requires such services.Level DNo actual harm, potential for moreCorrected May 15, 2026
- F760Ensure that residents are free from significant medication errors.Level DNo actual harm, potential for moreCorrected May 15, 2026
- F849Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.Level DNo actual harm, potential for moreCorrected May 15, 2026
- F880Provide and implement an infection prevention and control program.Level DNo actual harm, potential for moreCorrected May 15, 2026
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Feb 192026
Complaint investigation
2 findings
- F760Ensure that residents are free from significant medication errors.Level DNo actual harm, potential for moreCorrected Mar 11, 2026
- F849Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.Level DNo actual harm, potential for moreCorrected Mar 11, 2026
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Jan 72026
Complaint investigation
2 findings
- F658Ensure services provided by the nursing facility meet professional standards of quality.Level DNo actual harm, potential for moreCorrected Jan 16, 2026
- F880Provide and implement an infection prevention and control program.Level DNo actual harm, potential for moreCorrected Jan 16, 2026
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Dec 82025
Complaint investigation
1 finding
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level ENo actual harm, potential for moreCorrected Dec 13, 2025
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Nov 252025
Complaint investigation
2 findings
- F880Provide and implement an infection prevention and control program.Level HActual harmCorrected Dec 13, 2025
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level GActual harmCorrected Dec 13, 2025
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Apr 22025
Standard health inspection
4 findings
The same visit included a complaint investigation.
- F610Respond appropriately to all alleged violations.Level DNo actual harm, potential for moreCorrected May 1, 2025
- F658Ensure services provided by the nursing facility meet professional standards of quality.Level DNo actual harm, potential for moreCorrected May 1, 2025
- F726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.Level DNo actual harm, potential for moreCorrected May 1, 2025
- F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.Level DNo actual harm, potential for moreCorrected May 1, 2025
Enforcement Action
Civil money penalty, $19,884 imposed November 25, 2025. CMS publishes the fine, not whether it has been paid. CMS does not tie a penalty to a survey; listed with the standard health inspection of April 2, 2025, the nearest before the penalty date.
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Nov 72024
Complaint investigation
1 finding
- F695Provide safe and appropriate respiratory care for a resident when needed.Level ENo actual harm, potential for moreCorrected Nov 25, 2024
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Oct 82024
Complaint investigation
1 finding
- F658Ensure services provided by the nursing facility meet professional standards of quality.Level DNo actual harm, potential for moreCorrected Oct 21, 2024
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Apr 112024
Standard health inspection
3 findings
The same visit included a complaint investigation.
- F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Level FNo actual harm, potential for moreCorrected Apr 30, 2024
- F880Provide and implement an infection prevention and control program.Level FNo actual harm, potential for moreCorrected Apr 30, 2024
- F757Ensure each resident’s drug regimen must be free from unnecessary drugs.Level ENo actual harm, potential for moreCorrected Apr 30, 2024
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Feb 292024
Complaint investigation
1 finding
- F757Ensure each resident’s drug regimen must be free from unnecessary drugs.Level DNo actual harm, potential for moreCorrected Mar 22, 2024
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)

Severity levels follow the CMS scope and severity grid. A–C: potential for minimal harm. D–F: no actual harm, potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy.

Context

Patterns Worth Examining

A repeated citation can merit attention, but context and corrective action must be reviewed before drawing a conclusion.

1
Infection Control, Cited in Four Inspections
Inspectors cited F880 in April 2024, November 2025, January 2026 and April 2026. This citation covers hand hygiene, isolation practice and the home’s infection-prevention program. The most serious of these was recorded at level H (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
24242424252525262626F880 across all 10 inspections, oldest to newest
2
Professional Standards, Cited in Three Inspections
Inspectors cited F658 in October 2024, April 2025 and January 2026. This citation covers whether the home’s services meet professional standards of quality. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
24242424252525262626F658 across all 10 inspections, oldest to newest
3
Quality of Care, Cited in Three Inspections
Inspectors cited F684 in November 2025, December 2025 and April 2026. This citation covers whether residents receive the treatment their orders, preferences and goals call for. The most serious of these was recorded at level G (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
24242424252525262626F684 across all 10 inspections, oldest to newest
4
Investigating Alleged Violations, Cited in Two Inspections
Inspectors cited F610 in April 2025 and April 2026. This citation covers how the home responds to and investigates an allegation of abuse, neglect or mistreatment. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
24242424252525262626F610 across all 10 inspections, oldest to newest
5
Citation F757, Cited in Two Inspections
Inspectors cited F757 in February 2024 and April 2024. The agency describes it this way: Ensure each resident’s drug regimen must be free from unnecessary drugs. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
24242424252525262626F757 across all 10 inspections, oldest to newest
6
Significant Medication Errors, Cited in Two Inspections
Inspectors cited F760 in February 2026 and April 2026. This citation covers whether residents are free from significant medication errors. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
24242424252525262626F760 across all 10 inspections, oldest to newest
7
Citation F849, Cited in Two Inspections
Inspectors cited F849 in February 2026 and April 2026. The agency describes it this way: 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. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
24242424252525262626F849 across all 10 inspections, oldest to newest

For Your Next Visit

Questions to Ask on Your Visit

Bring these to the tour. Each one comes from something in the record; the reason is under the question.

01
Who leads infection control here, and how often are hand-hygiene and isolation practices audited?
Infection Control: cited in four inspections, most seriously at level H.
02
How do you check that nurses and aides follow professional standards, and what happens when they do not?
Professional Standards: cited in three inspections, most seriously at level D.
03
How do nurses make sure a doctor’s orders are carried out, and how are families told when something is missed?
Quality of Care: cited in three inspections, most seriously at level G.
04
When an allegation is made, who investigates it, and how are residents protected in the meantime?
Investigating Alleged Violations: cited in two inspections, most seriously at level D.
05
What changed after F757 was cited, and how do you check it now?
Citation F757: cited in two inspections, most seriously at level E.
06
What happened after the medication error citation, and how are high-risk drugs double-checked?
Significant Medication Errors: cited in two inspections, most seriously at level D.
07
What changed after F849 was cited, and how do you check it now?
Citation F849: cited in two inspections, most seriously at level D.
08
How many nurses and aides are on each shift, including nights and weekends, for the unit we are considering?
No staffing citation appears in this window. Staffing levels are published separately by CMS and are worth asking about directly.
09
What led to the 2025 fine, and has it been paid?
A $19,884 civil money penalty was imposed November 25, 2025. CMS publishes the fine, not whether it has been paid.

The Evidence

Sources and Coverage

Inspection results and penalties are published by the Centers for Medicare & Medicaid Services from surveys conducted by the Rhode Island state survey agency.

Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Feb 29, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Apr 11, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Oct 8, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Nov 7, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Apr 2, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Nov 25, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Dec 8, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Jan 7, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Feb 19, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Rhode Island state survey agency
Inspection Apr 30, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Penalties, Provider Data Catalog
Centers for Medicare & Medicaid Services
Published Oct 1, 2026 · Retrieved Nov 1, 2026
View Dataset ↗
Provider Information, Provider Data Catalog
Centers for Medicare & Medicaid Services · 415040
Published Oct 1, 2026 · Retrieved Nov 1, 2026
View Dataset ↗

Coverage

Record windowFebruary 29, 2024 – October 1, 2026

CMS publishes about three inspection cycles; inspections before February 2024 are not in this release.
CMS refreshes these files monthly, after statements of deficiencies are processed, so an inspection from the last two months may not appear yet.

What This Report Cannot Tell You

Complaints not investigated onsite: Allegations screened out by the state before an onsite visit are not published.
Complaint allegations: CMS publishes the deficiencies a complaint survey cited, not the allegation itself.
Facility-reported incidents: Self-reported incidents appear only if they led to an inspection.
Follow-up visits: CMS's files list standard, complaint and infection control surveys, not revisits; a correction date is the one CMS records.
Fire safety inspections: Published by CMS separately and not included in this record yet.
Staffing levels and ownership history: Published by CMS separately and not included in this record.
Whether fines were paid: CMS publishes the fines imposed, not whether or when they were paid.

Historical coverage varies by agency and location. Missing records do not mean that no complaint or violation occurred.

Data architecture: Cierto supplies the source-backed machine-readable bundle. Life by Vardell independently creates the narrative, design, and consumer report.