SNF
Royal Middletown Nursing Center
CCN: 415040 · Middletown, RI 02842 · Newport County
Overview
- Address
- 193 Forest Avenue, Middletown, RI 02842
- Phone
- 4018472777
- Certified beds
- 50
- Avg daily residents
- 44 (88% of beds filled)
- Ownership
- For-profit partnership
- Provider type
- Medicare and Medicaid
- Medicare/Medicaid since
- 1974-03-31
- Setting
- Urban
3 /5
★★★★★
CMS Overall Rating
CMS 5-Star Ratings
CMS rates every Medicare/Medicaid-certified nursing home on four domains. The Overall rating is driven primarily by Health Inspection results, then adjusted up or down by Staffing and Quality Measures.
Staffing & Workforce
Direct-care staffing is the strongest operational driver of quality in nursing homes. Values are hours per resident per day, derived from payroll-based journal (PBJ) submissions. "Case-mix" adjusts for resident acuity; "Adjusted" is the CMS rating-input value.
| Role | Reported | Case-mix expected | Adjusted | Federal floor | |
|---|---|---|---|---|---|
| Total nurse All nursing staff combined: RN + LPN + Aide | 3.00 | 3.82 | 3.03 | ≥ 3.48 | Below floor |
| Registered Nurse (RN) Licensed RN hours. Strongest driver of clinical outcomes. | 0.95 | 0.67 | 0.96 | ≥ 0.55 | |
| Licensed Practical Nurse (LPN) LPN/LVN hours. Often handles medication administration. | 0.04 | 0.85 | 0.04 | — | |
| Nurse aide CNA hours. Bulk of direct resident care — bathing, feeding, mobility. | 2.00 | 2.30 | 2.03 | — | |
| Licensed (RN + LPN) Combined licensed nurse coverage. | 1.00 | — | — | — | |
| Physical therapist Rehabilitation therapist hours — important for post-acute / rehab admissions. | 0.02 | — | — | — |
Federal minimums (phasing in under the CMS 2024 minimum staffing rule) shown for reference. RN: 0.55 hrs/resident/day. Total nurse: 3.48 hrs/resident/day.
Weekend staffing
Total nurse (weekend)
2.52
hrs / resident / day
RN (weekend)
0.63
hrs / resident / day
Total nurse (adjusted, weekend)
2.55
hrs / resident / day
Weekend under-staffing is a common quality-of-care concern — adverse events are more frequent when licensed coverage drops.
Staff turnover
Total nursing staff turnover
79.6%
annual
RN turnover
94.1%
annual
Administrators departed
0
last 12 months
Resident acuity
Nursing Case-Mix Index
1.35
higher acuity than avg
Case-Mix Index Ratio
0.98
facility / state ratio
Health Inspections
CMS weights three inspection cycles to compute the Health Inspection rating: the most recent (50%), the second most recent (33%), and the oldest (17%). Each standard-survey deficiency is assigned a score based on scope and severity; complaint-survey findings and revisit scores are added to produce the cycle total.
| Cycle | Date | Total defs. | Standard | Complaint | Deficiency score | Revisits | Total score |
|---|---|---|---|---|---|---|---|
| Cycle 1 (most recent) | 2025-04-02 | 9 | 3 | 6 | 87 | 1 | 87 |
| Cycle 2/3 (prior) | 2024-04-11 | 6 | 3 | 6 | 56 | 1 | 56 |
Total weighted health score
79.3
lower is better
Deficiencies (24)
Individual survey findings. Scope/severity uses the CMS A–L matrix: letters further down the alphabet indicate greater harm and wider scope, up through J–L (immediate jeopardy).
22 D/E/F Actual harm — potential for minor
2 G/H/I Actual harm
| Tag | Description | Scope/Severity | Survey date | Corrected |
|---|---|---|---|---|
| 0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2026-01-07 | 2026-01-16 |
| 0880 | Provide and implement an infection prevention and control program. | D | 2026-01-07 | 2026-01-16 |
| 0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | E | 2025-12-08 | 2025-12-13 |
| 0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | G | 2025-11-25 | 2025-12-13 |
| 0880 | Provide and implement an infection prevention and control program. | H | 2025-11-25 | 2025-12-13 |
| 0610 | Respond appropriately to all alleged violations. | D | 2025-04-02 | 2025-05-01 |
| 0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2025-04-02 | 2025-05-01 |
| 0726 | 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. | D | 2025-04-02 | 2025-05-01 |
| 0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | 2025-04-02 | 2025-05-01 |
| 0695 | Provide safe and appropriate respiratory care for a resident when needed. | E | 2024-11-07 | 2024-11-25 |
| 0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2024-10-08 | 2024-10-21 |
| 0757 | Ensure each resident’s drug regimen must be free from unnecessary drugs. | E | 2024-04-11 | 2024-04-30 |
| 0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | 2024-04-11 | 2024-04-30 |
| 0880 | Provide and implement an infection prevention and control program. | F | 2024-04-11 | 2024-04-30 |
| 0757 | Ensure each resident’s drug regimen must be free from unnecessary drugs. | D | 2024-02-29 | 2024-03-22 |
| 0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | 2023-02-08 | 2023-03-10 |
| 0610 | Respond appropriately to all alleged violations. | D | 2023-02-08 | 2023-03-10 |
| 0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2023-02-08 | 2023-03-10 |
| 0695 | Provide safe and appropriate respiratory care for a resident when needed. | D | 2023-02-08 | 2023-03-10 |
| 0698 | Provide safe, appropriate dialysis care/services for a resident who requires such services. | E | 2023-02-08 | 2023-03-10 |
| 0759 | Ensure medication error rates are not 5 percent or greater. | D | 2023-02-08 | 2023-03-10 |
| 0770 | Provide timely, quality laboratory services/tests to meet the needs of residents. | D | 2023-02-08 | 2023-03-10 |
| 0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | E | 2023-02-08 | 2023-03-10 |
| 0880 | Provide and implement an infection prevention and control program. | F | 2023-02-08 | 2023-03-10 |
Financial Health (FY 2023)
Payer mix (share of resident days)
Medicare 10.2% Medicaid 51.0% Other 38.7%
Operating performance
Operating Margin
-30.2%
Total Margin
-14.5%
Occupancy Rate
66.5%
Cost per Resident Day
$38
Revenue & costs
Net Patient Revenue
$3.8M
Total Costs
$456K
Net Income
-$634K
Balance sheet
Total Assets
$849K
Total Liabilities
$2.9M
Fund Balance
-$2.1M
Current Ratio
1.48
Source: CMS SNF Cost Report (FY 2023). Cost report data lags by ~2 years.
Ownership & Corporate Structure
Chain: ROYAL HEALTH GROUP
- Chain ID
457- Facilities in chain
- 12
- Legal business name
- ROYAL MIDDLETOWN NURSING CENTER LLC
Chain-average star ratings (for peer context)
Overall
3.3
Health
3.3
Staffing
2.3
QM
3.3
Owner / manager individuals (3)
| Name | Role | Association |
|---|---|---|
| MAMARY, JAMES | 5% OR GREATER DIRECT OWNERSHIP INTEREST | since 01/14/2016 |
| MAMARY, JONATHAN | 5% OR GREATER DIRECT OWNERSHIP INTEREST | since 01/14/2016 |
| MAMARY, JAMES | OPERATIONAL/MANAGERIAL CONTROL | since 08/19/2016 |
Source: CMS Nursing Home Ownership. Percent ownership is rarely disclosed — CMS only requires it for specific roles.
Facility Features
- CCRC
- No
- Hospital-based
- No
- Resident / family council
- Resident
- Sprinkler systems
- Yes
- Abuse citation flag
- No
Methodology & sources
- Nursing Home Provider Info (
nh-provider-info), vintage 2026, downloaded 2026-04-14 , 14,703 rows. - Nursing Home Health Deficiencies (
nh-deficiencies), vintage 2026, downloaded 2026-04-14 , 418,972 rows. - Nursing Home Ownership (
nh-ownership), vintage 2026, downloaded 2026-04-14 , 160,393 rows. - Skilled Nursing Facility Cost Report (
snf-cost-report), vintage 2023, downloaded 2026-04-14 , 14,120 rows.
All Data
Every labeled field shipped for this facility by CMS. No national median or percentile context is available for SNFs in the current release.
Show 113 rows
| Source | Metric | Value | Raw key |
|---|---|---|---|
| Cost Report | Cost per Resident Day ($) | $38 | metrics.cost_per_resident_day |
| Cost Report | Current Ratio | 1.48 | metrics.current_ratio |
| Cost Report | fiscal_year | 2,023 | fiscal_year |
| Cost Report | Medicaid Day Share (%) | 51.0% | metrics.medicaid_day_share |
| Cost Report | Medicare Day Share (%) | 10.2% | metrics.medicare_day_share |
| Cost Report | Net Income ($) | $-633,616 | metrics.net_income |
| Cost Report | Net Patient Revenue ($) | $3,842,686 | metrics.net_patient_revenue |
| Cost Report | Occupancy Rate (%) | 66.5% | metrics.occupancy_rate |
| Cost Report | Operating Margin (%) | -30.2% | metrics.operating_margin |
| Cost Report | Total Assets ($) | $849,011 | metrics.total_assets |
| Cost Report | Total Costs ($) | $455,744 | metrics.total_costs |
| Cost Report | Total Fund Balances ($) | $-2,066,620 | metrics.fund_balance |
| Cost Report | Total Liabilities ($) | $2,915,631 | metrics.total_liabilities |
| Cost Report | Total Margin (%) | -14.5% | metrics.total_margin |
| Provider Information | Abuse Icon | N | Abuse Icon |
| Provider Information | Adjusted LPN Staffing Hours per Resident per Day | 0.04429 | Adjusted LPN Staffing Hours per Resident per Day |
| Provider Information | Adjusted Nurse Aide Staffing Hours per Resident per Day | 2.02638 | Adjusted Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Adjusted RN Staffing Hours per Resident per Day | 0.96187 | Adjusted RN Staffing Hours per Resident per Day |
| Provider Information | Adjusted Total Nurse Staffing Hours per Resident per Day | 3.03254 | Adjusted Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Adjusted Weekend Total Nurse Staffing Hours per Resident per Day | 2.54718 | Adjusted Weekend Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Administrator turnover footnote | — | Administrator turnover footnote |
| Provider Information | Automatic Sprinkler Systems in All Required Areas | Yes | Automatic Sprinkler Systems in All Required Areas |
| Provider Information | Average Number of Residents per Day | 43.8 | Average Number of Residents per Day |
| Provider Information | Average Number of Residents per Day Footnote | — | Average Number of Residents per Day Footnote |
| Provider Information | Case-Mix LPN Staffing Hours per Resident per Day | 0.84759 | Case-Mix LPN Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Nurse Aide Staffing Hours per Resident per Day | 2.30357 | Case-Mix Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Case-Mix RN Staffing Hours per Resident per Day | 0.66809 | Case-Mix RN Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Total Nurse Staffing Hours per Resident per Day | 3.81926 | Case-Mix Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day | 3.36627 | Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Chain Average Health Inspection Rating | 3.3 | Chain Average Health Inspection Rating |
| Provider Information | Chain Average Overall 5-star Rating | 3.3 | Chain Average Overall 5-star Rating |
| Provider Information | Chain Average QM Rating | 3.3 | Chain Average QM Rating |
| Provider Information | Chain Average Staffing Rating | 2.3 | Chain Average Staffing Rating |
| Provider Information | Chain ID | 457 | Chain ID |
| Provider Information | Chain Name | ROYAL HEALTH GROUP | Chain Name |
| Provider Information | City/Town | Middletown | City/Town |
| Provider Information | CMS Certification Number (CCN) | 415040 | CMS Certification Number (CCN) |
| Provider Information | Continuing Care Retirement Community | N | Continuing Care Retirement Community |
| Provider Information | County/Parish | Newport | County/Parish |
| Provider Information | Date First Approved to Provide Medicare and Medicaid Services | 1974-03-31 | Date First Approved to Provide Medicare and Medicaid Services |
| Provider Information | Geocoding Footnote | — | Geocoding Footnote |
| Provider Information | Health Inspection Rating | 3 | Health Inspection Rating |
| Provider Information | Health Inspection Rating Footnote | — | Health Inspection Rating Footnote |
| Provider Information | Latitude | 41.5282 | Latitude |
| Provider Information | Legal Business Name | ROYAL MIDDLETOWN NURSING CENTER LLC | Legal Business Name |
| Provider Information | Location | 193 Forest Avenue,Middletown,RI,02842 | Location |
| Provider Information | Long-Stay QM Rating | 1 | Long-Stay QM Rating |
| Provider Information | Long-Stay QM Rating Footnote | — | Long-Stay QM Rating Footnote |
| Provider Information | Longitude | -71.289 | Longitude |
| Provider Information | Most Recent Health Inspection More Than 2 Years Ago | N | Most Recent Health Inspection More Than 2 Years Ago |
| Provider Information | Number of administrators who have left the nursing home | 0 | Number of administrators who have left the nursing home |
| Provider Information | Number of Certified Beds | 50 | Number of Certified Beds |
| Provider Information | Number of Citations from Infection Control Inspections | — | Number of Citations from Infection Control Inspections |
| Provider Information | Number of Facilities in Chain | 12 | Number of Facilities in Chain |
| Provider Information | Number of Fines | 0 | Number of Fines |
| Provider Information | Number of Payment Denials | 0 | Number of Payment Denials |
| Provider Information | Nursing Case-Mix Index | 1.35299 | Nursing Case-Mix Index |
| Provider Information | Nursing Case-Mix Index Ratio | 0.98210 | Nursing Case-Mix Index Ratio |
| Provider Information | Overall Rating | 3 | Overall Rating |
| Provider Information | Overall Rating Footnote | — | Overall Rating Footnote |
| Provider Information | Ownership Type | For profit - Partnership | Ownership Type |
| Provider Information | Physical Therapist Staffing Footnote | — | Physical Therapist Staffing Footnote |
| Provider Information | Processing Date | 2026-03-01 | Processing Date |
| Provider Information | Provider Address | 193 Forest Avenue | Provider Address |
| Provider Information | Provider Changed Ownership in Last 12 Months | N | Provider Changed Ownership in Last 12 Months |
| Provider Information | Provider Name | Royal Middletown Nursing Center | Provider Name |
| Provider Information | Provider Resides in Hospital | N | Provider Resides in Hospital |
| Provider Information | Provider SSA County Code | 020 | Provider SSA County Code |
| Provider Information | Provider Type | Medicare and Medicaid | Provider Type |
| Provider Information | QM Rating | 2 | QM Rating |
| Provider Information | QM Rating Footnote | — | QM Rating Footnote |
| Provider Information | Rating Cycle 1 Health Deficiency Score | 87 | Rating Cycle 1 Health Deficiency Score |
| Provider Information | Rating Cycle 1 Health Revisit Score | 0 | Rating Cycle 1 Health Revisit Score |
| Provider Information | Rating Cycle 1 Number of Complaint Health Deficiencies | 6 | Rating Cycle 1 Number of Complaint Health Deficiencies |
| Provider Information | Rating Cycle 1 Number of Health Revisits | 1 | Rating Cycle 1 Number of Health Revisits |
| Provider Information | Rating Cycle 1 Number of Standard Health Deficiencies | 3 | Rating Cycle 1 Number of Standard Health Deficiencies |
| Provider Information | Rating Cycle 1 Standard Survey Health Date | 2025-04-02 | Rating Cycle 1 Standard Survey Health Date |
| Provider Information | Rating Cycle 1 Total Health Score | 87 | Rating Cycle 1 Total Health Score |
| Provider Information | Rating Cycle 1 Total Number of Health Deficiencies | 9 | Rating Cycle 1 Total Number of Health Deficiencies |
| Provider Information | Rating Cycle 2 Number of Standard Health Deficiencies | 3 | Rating Cycle 2 Number of Standard Health Deficiencies |
| Provider Information | Rating Cycle 2 Standard Health Survey Date | 2024-04-11 | Rating Cycle 2 Standard Health Survey Date |
| Provider Information | Rating Cycle 2/3 Health Deficiency Score | 56 | Rating Cycle 2/3 Health Deficiency Score |
| Provider Information | Rating Cycle 2/3 Health Revisit Score | 0 | Rating Cycle 2/3 Health Revisit Score |
| Provider Information | Rating Cycle 2/3 Number of Complaint Health Deficiencies | 6 | Rating Cycle 2/3 Number of Complaint Health Deficiencies |
| Provider Information | Rating Cycle 2/3 Number of Health Revisits | 1 | Rating Cycle 2/3 Number of Health Revisits |
| Provider Information | Rating Cycle 2/3 Total Health Score | 56 | Rating Cycle 2/3 Total Health Score |
| Provider Information | Rating Cycle 2/3 Total Number of Health Deficiencies | 6 | Rating Cycle 2/3 Total Number of Health Deficiencies |
| Provider Information | Registered Nurse hours per resident per day on the weekend | 0.62703 | Registered Nurse hours per resident per day on the weekend |
| Provider Information | Registered Nurse turnover | 94.1 | Registered Nurse turnover |
| Provider Information | Registered Nurse turnover footnote | — | Registered Nurse turnover footnote |
| Provider Information | Reported Licensed Staffing Hours per Resident per Day | 0.99530 | Reported Licensed Staffing Hours per Resident per Day |
| Provider Information | Reported LPN Staffing Hours per Resident per Day | 0.04381 | Reported LPN Staffing Hours per Resident per Day |
| Provider Information | Reported Nurse Aide Staffing Hours per Resident per Day | 2.00451 | Reported Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Reported Physical Therapist Staffing Hours per Resident Per Day | 0.02452 | Reported Physical Therapist Staffing Hours per Resident Per Day |
| Provider Information | Reported RN Staffing Hours per Resident per Day | 0.95148 | Reported RN Staffing Hours per Resident per Day |
| Provider Information | Reported Staffing Footnote | — | Reported Staffing Footnote |
| Provider Information | Reported Total Nurse Staffing Hours per Resident per Day | 2.99981 | Reported Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Short-Stay QM Rating | 3 | Short-Stay QM Rating |
| Provider Information | Short-Stay QM Rating Footnote | — | Short-Stay QM Rating Footnote |
| Provider Information | Special Focus Status | — | Special Focus Status |
| Provider Information | Staffing Rating | 2 | Staffing Rating |
| Provider Information | Staffing Rating Footnote | — | Staffing Rating Footnote |
| Provider Information | State | RI | State |
| Provider Information | Telephone Number | 4018472777 | Telephone Number |
| Provider Information | Total Amount of Fines in Dollars | 0.00 | Total Amount of Fines in Dollars |
| Provider Information | Total number of nurse staff hours per resident per day on the weekend | 2.51969 | Total number of nurse staff hours per resident per day on the weekend |
| Provider Information | Total Number of Penalties | 0 | Total Number of Penalties |
| Provider Information | Total nursing staff turnover | 79.6 | Total nursing staff turnover |
| Provider Information | Total nursing staff turnover footnote | — | Total nursing staff turnover footnote |
| Provider Information | Total Weighted Health Survey Score | 79.250 | Total Weighted Health Survey Score |
| Provider Information | Urban | Y | Urban |
| Provider Information | With a Resident and Family Council | Resident | With a Resident and Family Council |
| Provider Information | ZIP Code | 02842 | ZIP Code |