Royal Middletown Nursing Center

Inspectors wroteBased on record review and staff interview, the facility failed to ensure that prospective employees were screened for a history of abuse, neglect, exploitation, or misappropriation of resident property, as evidenced by 1 of 1 personnel record reviewed for abuse Nursing Assistant (NA), Staff A.

Inspectors wroteBased on surveyor observation, clinical record review, and staff interview, the facility failed to ensure residents are treated with respect and dignity relative to 1 of 1 resident observed who was unable to attend meals and activities with his/her fellow peers due to lack of appropriate clothing, Resident ID #3.

Inspectors wroteBased on record review and staff interview, the facility failed to keep a resident free from sexual abuse for 1 of 2 residents reviewed, Resident ID #11.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that allegations made by residents are recognized as possible abuse by staff and that all allegations are investigated, for 1 of 2 resident's reviewed for abuse, Resident ID #41.

Inspectors wroteBased on clinical record review, surveyor observations, and staff interview, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 1 resident reviewed for following physician orders, Resident ID #32, for 1 of 2 residents reviewed for abuse, Resident ID #11 and for 1 of 2 residents reviewed for wound observations, Resident ID #40.

Inspectors wroteBased on clinical record review, resident and staff interview, the facility failed to ensure that pain management is provided to residents who require such services, consistent with professional standards of practice for 1 of 2 residents reviewed for pain, Resident ID #17.

Inspectors wroteBased on clinical record review and staff interview the facility failed to ensure that residents are free of any significant medication errors for 1 of 2 residents reviewed for antibiotic use, Resident ID #17.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that hospice services meet professional standards of principles that apply to individuals providing services in the facility for 1 of 2 residents reviewed who are receiving hospice services, Resident ID #11.

Inspectors wroteBased on clinical record review, surveyor observation, and staff interview, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections relative to a clean dressing change for 1 of 2 residents observed for wound care, Resident ID #40.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that residents are free of any significant medication errors for 1 of 3 residents reviewed for end-of-life comfort medications, Resident ID #1.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that hospice services meet professional standards and principles that apply to individuals providing services in the facility for 1 of 3 residents reviewed who is receiving hospice care, Resident ID #1.

Inspectors wroteBased on clinical record review and staff interview, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for 1 of 1 resident reviewed for blood pressure medications with parameters, Resident ID #3.

Inspectors wroteBased on clinical record review, surveyor observation, and staff interview, the facility failed to maintain an infection prevention and control program to help prevent the transmission of communicable diseases and infections relative to not following transmission-based precautions for 1 of 2 residents reviewed, Resident ID #4.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that a resident with wounds receives necessary treatment and services, consistent with professional standards of practice, to promote healing for 2 of 2 residents reviewed for wounds, Resident ID #s 1 and 2.

Inspectors wroteBased on surveyor observation, record review, and staff interview, the facility failed to; obtain, review, and report laboratory tests, as ordered, and complete ordered COVID-19 testing upon admission and on subsequent days for 2 of 3 newly admitted residents reviewed, Resident ID #s 1 and 2. The facility's failure involved urinary tract infection (UTI) related laboratory testing and follow-up, and the failure to obtain Covid-19 testing, as ordered, resulted in a delay of care, including the hospitalization of Resident ID #1 with diagnoses including Covid-19 and a UTI.

Inspectors wroteBased on surveyor observation, record review, and staff interview, the facility failed to; obtain, review, and report laboratory tests, as ordered; notify a provider of abnormal or missing test results; and complete ordered COVID-19 testing upon admission and subsequent days for 2 of 3 newly admitted residents reviewed, Resident ID #s 1 and 2. The facility's failure involved UTI-related laboratory testing and follow-up, that resulted in a delay of care, including the hospitalization of Resident ID #1. Review of a community reported complaint submitted to the Rhode Island Department of Health on 11/18/2025 alleged in part that the facility had a Covid-19 outbreak, and that Resident ID #1 was now positive for Covid-19. The complaint further alleged that the resident had blood in his/her urine and was not receiving care that s/he should.1. [...]

Inspectors wroteBased on record review, resident and staff interview, it has been determined that the facility failed to ensure that all alleged violations involving physical abuse are thoroughly investigated for 1 of 1 resident reviewed, Resident ID #31.

Inspectors wroteBased on surveyor observation, record review and staff interview, it has been determined that the facility failed to ensure residents receive treatment and care in accordance with professional standards of practice relative to following physician's orders for 1 of 1 resident with an order for foam boots (cushioned boots use to reduce the risk of developing a pressure ulcer [a wound that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged period]), Resident ID #14.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that nursing staff have the appropriate competencies and skill sets to provide nursing and related services to assure resident safety, relative to a peripherally inserted central catheter (PICC; a long flexible tube that is inserted into a vein in the arm and threaded through a larger vein leading to the heart, used to administer intravenous (IV) fluids and medications) for 1 of 1 resident reviewed with a PICC line, Resident ID #34.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that medical records for each resident are accurately documented for 2 of 2 residents reviewed relative to a fluid restriction, Resident ID #'s 18 and 25, for 1 of 3 residents reviewed relative to insulin administration, Resident ID #2, and for 1 of 1 resident reviewed relative to pressure relieving devices, Resident ID #14.

Inspectors wroteBased on surveyor observation, record review, and resident and staff interview, it has been determined that the facility failed to provide respiratory care consistent with professional standards of practice for 2 of 3 residents reviewed for oxygen (O2) use, Resident ID #s 1 and 4.

Inspectors wroteBased on record review, and staff interview, it has been determined that the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice relative to following physician's orders for 1 of 3 residents reviewed relative to medication administration, Resident ID #1.

Inspectors wroteBased on surveyor observation, record review, and staff interview, it has been determined that the facility failed to store food in accordance with professional standards of food service safety relative to the main kitchen.

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to implement a water management program based upon industry standards and/or the Centers for Disease Control and Prevention (CDC) toolkit and failed to perform and document specified testing for the prevention of Legionella disease (a very serious type of pneumonia (lung infection) caused by the bacteria called Legionella.)

Inspectors wroteBased on record review and staff interview, it has been determined that the facility failed to ensure that the resident's drug regimen is free from unnecessary drugs for 1 of 2 residents reviewed with medication parameters, Resident ID #6.

Inspectors wroteBased on record review, resident, and staff interview, it has been determined that the facility failed to ensure a resident's drug regimen is free from unnecessary drugs, for 1 of 3 residents reviewed for Respiratory Syncytial Virus (RSV, a virus that affects the respiratory tract) vaccine.