Royal Middletown Nursing Center

F 0684 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

but not limited to, a UTI and Covid. Further review of hospital documentation revealed that as of 11/24/2025, Resident ID #1 remained in the hospital.During a surveyor interview on 11/24/2025 at approximately 11:00 AM with Registered Nurse (RN), Staff A, she indicated that the facility currently has a Covid-19 outbreak, which began on 11/17/2025. She further indicated that every resident should be tested for Covid on admission, on day two, and on day four. Additionally, she acknowledged that Resident ID #1 had not been tested for Covid-19 at all while admitted to the facility. Furthermore, she acknowledged that

the labs were not completed on 11/10/2025, as ordered, and that the positive UA C&S results on 11/14/2025 were not reported to a provider.During a surveyor interview on 11/24/2025 at approximately 1:45 PM, with the Infection Preventionist, she acknowledged that the labs were not completed on 11/10/2025, as ordered. She further acknowledged that Resident ID #1 was not tested for Covid on admission, on day two, or on day four, and that the facility currently has a Covid-19 outbreak. Additionally,

she indicated that the UA C&S results, dated 11/14/2025, were not viewed by any facility staff until 11/17/2025, the day the resident was sent to the hospital for shortness of breath, blood in his/her urostomy, and PCN tube. Furthermore, she acknowledged that a provider was not notified of the results and that interventions were not put into place. 2. Record review showed Resident #2 was admitted in November 2025 with diagnoses including a history of UTIs and muscle weakness. Review of a care plan dated 11/19/2025 revealed, the resident had a UTI with interventions including, but not limited to, to obtain and monitor lab results, as ordered.2a. Record review of the physician's order revealed the following:11/19/2025 to obtain a UA C&SRecord review failed to reveal evidence that the UA C&S was completed.

Additional record review revealed laboratory tests that included a CBC were obtained on 11/14/2025 and resulted the same day; however, the record failed to provide evidence of a physician's order. Furthermore,

the record failed to provide evidence that the abnormal results were reported to a provider, or that the UA C&S was obtained as ordered.2b. Record review revealed a physician's order dated 11/13/2025 to [Covid-19] Test new admissions or residents who have left the facility for more than 24 hours, regardless of vaccination status, on admission, day 2 and day 4.Record review failed to reveal evidence that Resident ID #2 was tested for Covid-19 on admission or on day two, as ordered.Record review revealed the resident tested positive for Covid on 11/21/2025.During a surveyor interview on 11/25/2025 at approximately 11:00 AM with RN, Staff B, she indicated that all new admissions are tested for Covid-19 on admission, day two, and day four, and acknowledged that Resident ID #2 had not been tested on admission or on day two, as ordered. She could not provide evidence of a physician's order for the labs obtained on 11/14/2025 or that a provider had been notified of the abnormal results. Additionally, she acknowledged that the UA C&S still had not been obtained, as ordered, and could not provide evidence that the provider had been notified.

During a surveyor interview on 11/25/2025 at 11:21 AM with the Director of Nursing Services, she indicated that she would expect physician's orders to be followed, as ordered, and that labs would be completed and reported to a provider. She further indicated that the Covid-19 outbreak began on 11/17/2025 and that 19 of 43 residents had tested positive as of 11/24/2025. During a surveyor interview on 11/25/2025 at approximately 11:45 AM with the Medical Director, she indicated that she would expect to be notified of lab results because she does not review results unless the facility notifies her. Additionally, she indicated that

she would expect physician's orders to be completed, as ordered, and that nurses document when providers are notified. 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.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Royal Middletown Nursing Center

193 Forest Avenue Middletown, RI 02842

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

dated 11/14/2025, were not viewed by any facility staff until 11/17/2025, the day the resident was sent to

the hospital for shortness of breath, blood in his/her urostomy, and PCN tube. Furthermore, she acknowledged that a provider was not notified of the results and that interventions were not put into place.

1. 2. Record review revealed Resident #2 was admitted in November 2025 with diagnoses including a history

of UTIs and muscle weakness. Review of a care plan dated 11/19/2025 revealed, the resident had a UTI with interventions including, but not limited to, to obtain and monitor lab results, as ordered.2a. Record

review of the physician's order revealed the following:- 11/19/2025 to obtain a UA C&SRecord review failed to reveal evidence that the UA C&S was completed as ordered. 2b. Record review revealed a physician's order dated 11/13/2025 to [Covid-19] Test new admissions or residents who have left the facility for more than 24 hours, regardless of vaccination status, on admission, day 2 and day 4.Record review failed to reveal evidence that Resident ID #2 was tested for Covid-19 on admission or on day two, as ordered.Record review revealed the resident tested positive for Covid on 11/21/2025.During a surveyor

interview on 11/25/2025 at approximately 11:00 AM with RN, Staff B, she indicated that all new admissions are tested for Covid-19 on admission, day two, and day four, and acknowledged that Resident ID #2 had not been tested on admission or on day two, as ordered. Additionally, she acknowledged that the UA C&S still had not been obtained, as ordered, and could not provide evidence that the provider had been notified.

During a surveyor interview on 11/25/2025 at 11:21 AM with the Director of Nursing Services, she indicated that she would expect physician's orders to be followed, and that labs would be completed and reported to

a provider. She further indicated that the Covid-19 outbreak began on 11/17/2025 and that 19 of 43 residents had tested positive as of 11/24/2025. During a surveyor interview on 11/25/2025 at approximately 11:45 AM with the Medical Director, she indicated that she would expect to be notified of lab results because she does not review results unless the facility notifies her. Additionally, she indicated that she would expect physician's orders to be completed and that nurses document when providers are notified.

The facility's failure involved UTI-related laboratory testing and follow-up, and failure to obtain Covid-19 testing as ordered, which resulted in a delay of care, including the hospitalization of Resident ID #1 with diagnoses including a UTI and Covid-19.

Event ID:

Facility ID:

If continuation sheet