Above average — CMS composite of the measures below.
The next survey window likely opens around January 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Royal Of Westerly Nursing Center during CMS and state inspections, most recent first.
Failure to Obtain Informed Consent for Psychotropic Medications: The facility did not document advance informed consent for psychotropic meds for 5 residents with diagnoses including dementia, depression, anxiety, psychotic features, and intellectual disabilities. Records lacked evidence that residents or representatives were told about new psychotropic meds, dose increases, risks, benefits, side effects, or treatment alternatives, and signed consent forms were not found. Interviews confirmed that representatives and residents were not consistently asked for consent and were not given the required medication information.
The facility did not ensure provider approval was obtained before hospice recommendations were implemented for three residents, including new antibiotic, pain, comfort, and medication-discontinuation orders. Staff entered the hospice-related orders into the chart, but interviews showed the provider was not contacted or did not recall approving them. The facility also administered metoprolol to a resident even when the resident’s systolic BP was below the ordered hold parameter, and the order lacked a task to verify BP before administration.
The facility failed to provide appropriate catheter care for two residents. One resident with an SP tube had no order in place for routine exchanges despite urology approval for in-facility exchanges at set intervals, and staff were unsure when the tube was last changed. Another resident with a Foley catheter had no physician order documenting the indication, catheter type and size, or balloon size, and the DON could not show that appropriate catheter-related treatment and services were provided.
Physician supervision was not ensured for 3 hospice residents. Hospice recommendations for one resident with Alzheimer’s disease, one resident with chronic pain, and one resident with dementia were implemented by nursing staff as telephone or verbal orders, but the record did not show that a provider was notified before the meds were started. Interviews showed staff often entered hospice orders first and placed them in a communication binder for later review, and the DON could not provide evidence that hospice residents’ medical care was supervised by a physician.
The facility failed to keep two hospice residents free from unnecessary drugs when antibiotics were started without documented evidence of infection meeting NHSN criteria. One resident with Alzheimer’s disease and dementia received amoxicillin-clavulanate for a presumed respiratory infection, and another resident with stroke received Bactrim for a suspected UTI despite normal WBC results and no documented UTI signs or symptoms. The NP, Medical Director, and DON were unable to show that the hospice antibiotic recommendations were reviewed for appropriateness.
Medication Storage and Labeling Deficiencies: Surveyors found multiple open, undated, or expired meds on 3 medication carts and in 1 med room, including UTI-Stat, Pro-Stat, lorazepam oral concentrate, Trelegy Ellipta, Wixela inhalers, Humalog insulin, and PPD solution. Staff acknowledged several items were not dated, some were expired, and some were not stored as directed by the manufacturer, including lorazepam that should have been refrigerated.
The facility failed to maintain an IPCP with an antibiotic stewardship program that included antibiotic use protocols and monitoring. For 3 residents receiving antibiotics for conditions including pneumonia and other diagnoses, record review found no evidence of an antibiotic review or time out after the antibiotics were started. During interview, the DON stated that the facility did not perform antibiotic time outs or reviews 48 to 72 hours after starting antibiotics, as required by CDC guidance.
A resident with lower-leg wounds did not receive appropriate wound treatment and was not placed on EBP as required. Surveyors observed a left lower-leg dressing with no physician order in place and a right lower-leg skin tear dressing that did not match the documented wound care dates. Staff interviews showed the wound was not promptly communicated or ordered, and the RN, NP, and DON could not provide evidence that wound care, PPE use, and documentation were appropriately managed.
A resident with a skin tear and a history of stroke had a wound care order for daily cleansing and dressing changes, but surveyors observed the dressing was still dated from several days earlier. The TAR showed the treatment as completed on two days when the RN acknowledged it had not been changed, and the DON could not provide evidence that the medical record was accurately maintained.
A resident with a history of chronic kidney disease and other conditions did not have a bowel movement for 28 shifts. The facility failed to follow its bowel protocol and laxative list policy, resulting in the resident being transferred to the hospital with an ileus and fecal impaction. The DON acknowledged the protocol was not followed.
A resident with an indwelling catheter was hospitalized with a UTI and acute kidney injury due to improper catheter placement and lack of monitoring. The facility failed to follow physician orders for catheter size and output monitoring, as acknowledged by the DNS.
A resident with acute kidney failure and cardiac arrhythmias experienced leg pain and swelling shortly after admission. Despite staff observations and resident complaints, the facility failed to notify the physician of the edema until a surveyor intervened, seven days after initial assessment. The resident's pain was inconsistently managed, and the lack of timely communication and care adjustments led to the resident being unable to be discharged as planned.
A resident in an LTC facility received an incorrect dosage of Lipitor due to a failure to discontinue the previous 20 mg dose when a new order for 10 mg was implemented. Despite the physician's approval to reduce the dosage, both doses were administered on multiple days, resulting in a total daily dose of 30 mg. The error was acknowledged by the LPN and DON, who could not provide evidence of the discontinuation of the 20 mg dose.
The facility failed to maintain proper infection control measures for two residents with multidrug-resistant organisms (MDROs). One resident with a MRSA infection was not managed under contact precautions, and medical supplies were not sanitized after use. Another resident with a history of ESBL was not placed on Enhanced Barrier Precautions (EBP) as required by facility policy. Staff acknowledged these lapses, which were confirmed by the Director of Nursing Services and the Infection Preventionist.
Failure to Obtain Informed Consent for Psychotropic Medications
Penalty
Summary
The facility failed to ensure residents and/or their representatives were informed in advance of the care to be furnished by the physician or other provider, including the risks, benefits, side effects, and treatment alternatives related to psychotropic medications. Clinical record review showed that for 5 of 5 residents reviewed for psychotropic consent, there was no evidence of signed consent forms or documentation that the required discussions occurred before psychotropic medications were started or increased. Resident #3 had diagnoses including Alzheimer’s disease and anxiety disorder, with severe cognitive impairment noted on MDS review. The resident was prescribed multiple psychotropic medications, including lorazepam, mirtazapine, trazodone, haloperidol oral concentrate, and ABH gel. The record did not show that the resident’s representative was informed in advance of new psychotropic medications or dosage increases, and it did not show discussion of risks, benefits, side effects, or treatment alternatives. No signed psychotropic consent form was found in the record. Resident #9 had Alzheimer’s disease and major depressive disorder with psychotic features and severe cognitive impairment. The resident received trazodone and quetiapine. The record did not show advance notification to the representative about new psychotropic medications or dosage increases, nor documentation of risks, benefits, side effects, or alternatives. The resident’s representative told the surveyor that consent had never been requested, that they usually found out after the fact, and that they had never signed a psychotropic consent form or discussed the medications, side effects, risks, benefits, or alternative treatments. The representative also stated they were unaware the resident was receiving trazodone. Resident #26 had dementia and depression with severe cognitive impairment, and was prescribed Effexor XR and lorazepam intensol. Resident #46 had depression and anxiety disorder, with intact cognition, and was prescribed alprazolam, buspirone, and sertraline. Resident #64 had intellectual disabilities and major depressive disorder, with moderately impaired cognition, and was prescribed buspirone, duloxetine, multiple trazodone orders, Seroquel, and divalproex sodium. For each of these residents, the record failed to show advance informed consent, documentation of risks and benefits, side effects, or treatment alternatives, and signed psychotropic consent forms were not found. Resident #46 stated during interview that the facility did not discuss alternative treatments, side effects, or risks/benefits before starting new psychotropic medications. Resident #64’s representative stated they had never been asked to provide consent and had not been told about side effects, risks, benefits, or alternative treatment methods before psychotropic medications were started.
Failure to follow hospice orders and medication hold parameters
Penalty
Summary
The facility failed to ensure that resident care and treatment were carried out in accordance with professional standards of practice for three residents receiving hospice services and one resident receiving metoprolol with a blood pressure hold parameter. For Resident ID #3, hospice recommended amoxicillin-clavulanate and MiraLAX after a hospice nurse visit, and facility records showed telephone orders entered by an LPN, but the record did not show that the provider was notified or approved the hospice recommendations before the medications were started. Interviews with the NP, Medical Director, and Unit Manager showed that the provider approval process was unclear and that the Medical Director did not recall approving the antibiotic. For Resident ID #5, hospice recommended scheduled and as-needed oxycodone after a hospice nurse visit. Facility records showed telephone orders entered by LPN staff for both oxycodone orders, but the record did not show evidence that a provider approved or was notified of the hospice recommendations before the medications were initiated. For Resident ID #48, hospice recommended discontinuing several medications and starting scheduled lorazepam, oxygen as needed, and Bactrim. Facility records showed that an LPN discontinued the listed medications and entered orders for lorazepam and Bactrim, and a progress note stated that the APRN and family were notified; however, staff later stated that no provider had actually been contacted before the hospice recommendations were implemented. The Medical Director stated he did not recall approving the recommendations, and the DON could not provide evidence of provider approval before the medication changes were made. For Resident ID #67, the physician ordered metoprolol succinate 12.5 mg daily with instructions to hold the medication if systolic blood pressure was below 110. The order did not have an associated task to ensure blood pressure was obtained before administration. The resident had blood pressure readings below the hold parameter on two occasions, yet the November 2025 MAR showed the metoprolol was administered both times when it should have been held. The Unit Manager acknowledged the blood pressures and stated the medication should have been held as ordered, and the DON was unable to provide evidence that the medication had been held according to the provider’s parameter.
Missing Catheter Orders and Incomplete Catheter Care Documentation
Penalty
Summary
The facility failed to provide appropriate treatment and services for a resident with a suprapubic catheter and a resident with an indwelling Foley catheter. One resident was admitted with obstructive and reflux uropathy and had an SP tube. A urology continuity of care form dated 11/6/2024 documented that the facility requested to complete catheter exchanges in the facility and reduce the exchange frequency from monthly urology visits, and the urologist approved exchanges at five-week intervals in the facility. However, the record did not show an order for routine catheter exchanges at five-week intervals, and staff acknowledged there was no order in place and were unsure when the SP tube was last exchanged. The nurse practitioner stated she would expect exchanges at least every 28 days and that an order should be in place. A second resident was admitted with retention of urine and had an indwelling Foley catheter, but the record did not show a physician order that included the indication for catheter use, the catheter type and size, or the balloon size. An LPN acknowledged the resident had a Foley catheter and should have orders in place. The DON was unable to provide evidence that the facility provided appropriate treatment and services related to either resident’s catheter care, and a provider order for the Foley catheter including catheter and balloon size was entered into the medical record after the surveyor brought the issue to the facility’s attention.
Physician Supervision Not Ensured for Hospice Residents
Penalty
Summary
The facility failed to ensure the medical care of each resident receiving hospice services was supervised by a physician for 3 of 3 residents reviewed. For Resident ID #3, who was admitted with Alzheimer’s disease and later enrolled in hospice, a hospice nurse recommended starting amoxicillin-clavulanate and Miralax after a visit. The medications were entered into the record by an LPN as telephone orders from the Medical Director, but the record did not show that the provider was notified of the hospice recommendations before the medications were started, and the orders were not signed by a provider as of the survey date. For Resident ID #5, who had chronic pain and was receiving hospice services, hospice recommended scheduled oxycodone and oxycodone as needed for pain after a hospice visit. The orders were entered into the resident’s record by two LPNs as telephone orders from the Medical Director. The record did not show evidence that a provider was notified of the hospice recommendations before the medications were initiated. For Resident ID #48, who had dementia and was receiving hospice services, hospice recommended discontinuing several medications and starting scheduled lorazepam, oxygen as needed, and Bactrim. Staff discontinued multiple medications, entered lorazepam and Bactrim orders into the record, and documented that the Medical Director had been notified verbally; however, staff later stated no provider had actually been contacted before the hospice recommendations were implemented. Interviews also revealed the facility’s process was to implement hospice recommendations and place the paper in a communication binder for later provider review, and the DON was unable to provide evidence that the medical care of each hospice resident was supervised by a physician.
Unnecessary Antibiotic Use in Two Hospice Residents
Penalty
Summary
The facility failed to ensure that the drug regimen was free from unnecessary drugs for 2 residents receiving hospice services who were started on antibiotics without evidence in the record that the medications were reviewed for appropriateness. The facility policy stated that antibiotic orders from consulting, specialty, or emergency providers were to be reviewed for appropriateness, and the facility used CDC/NHSN, McGeer, Loeb, or another surveillance tool to define infections. One resident, admitted with diagnoses including Alzheimer’s disease and dementia and later enrolled in hospice, had a hospice recommendation for amoxicillin-clavulanate 875-125 mg twice daily for 5 days, followed by a physician order for the same antibiotic. The record did not show signs or symptoms of a respiratory infection meeting NHSN surveillance criteria, and there was no evidence that the hospice recommendation was reviewed for appropriateness with the provider. The NP and Medical Director both stated they were unaware the resident had been started on an antibiotic, and the Medical Director could not provide evidence of an appropriateness review. A second resident, admitted with a diagnosis including stroke, had hospice notes documenting increased confusion, unresponsiveness, and a spouse questioning a urinary tract infection, after which hospice recommended Bactrim 800 mg twice daily for 7 days and a physician order was written. The record did not show signs or symptoms meeting NHSN criteria for a urinary tract infection, and lab results showed a WBC of 7.3 two days before the antibiotic was started. The record also lacked evidence that the hospice recommendation was reviewed for appropriateness, and the NP, Medical Director, and DON were unable to provide evidence that either resident had symptoms of infection or that the residents were kept free of unnecessary medications.
Medication Storage and Labeling Deficiencies
Penalty
Summary
Drugs and biologicals were not stored and labeled in accordance with accepted professional principles in 3 of 3 medication carts observed and 1 of 1 medication rooms observed. On the Westerly Unit medication cart, surveyors found an open, undated bottle of Nutricia UTI-Stat, an open, undated bottle of Nutricia Pro-Stat Concentrate, and an open, undated bottle of lorazepam oral concentrate for Resident ID #3 that was also supposed to be refrigerated. Staff A acknowledged that the medications were opened, undated, and that the lorazepam should have been refrigerated. On the Watch Hill Unit medication cart, surveyors found a Trelegy Ellipta inhaler dated 10/31/2025 for Resident ID #5 that was expired, and an open bottle of lorazepam oral concentrate for Resident ID #14 that was not stored in the refrigerator. Staff L acknowledged the inhaler was expired and the lorazepam was not stored properly. On the Mystic Unit medication cart, surveyors observed an open, undated bottle of UTI-Stat, an expired vial of Humalog insulin for Resident ID #30 with an open date of 1/15/2026 and expiration date of 2/12/2026, two open and undated Wixela inhalers for Resident ID #11, an open and undated Trelegy Ellipta for Resident ID #12, and an open and undated Wixela inhaler for Resident ID #22. Staff K acknowledged the insulin was expired and the inhalers were opened and undated. In the medication room, surveyors found an open, undated vial of tuberculin purified protein derivative solution, and Staff L acknowledged it was open and undated. The DON stated she would expect staff to date medications when opened and know when they should be discarded.
Failure to Monitor Antibiotic Use and Perform Antibiotic Time Outs
Penalty
Summary
The facility failed to establish an Infection Prevention and Control Program that included an antibiotic stewardship program with antibiotic use protocols and a system to monitor antibiotic use. Clinical record review and staff interview showed that for 3 of 3 residents reviewed for antibiotic use, there was no evidence of an antibiotic review or antibiotic time out after antibiotics were started. The residents reviewed were admitted or readmitted with diagnoses including pneumonia, respiratory failure, Alzheimer's disease, dementia, and stroke, and each had a physician order for an antibiotic during the survey review period. Resident ID #1 was readmitted with diagnoses including pneumonia and respiratory failure and had an order for Cefdinir 300 mg orally twice daily for 7 days for pneumonia. Resident ID #3 had diagnoses including Alzheimer's and dementia and had an order for Amoxicillin Clavulanate 875-125 mg twice daily for 5 days. Resident ID #48 had a diagnosis including stroke and had an order for Bactrim 800 mg every 12 hours for 7 days. During interview, the DON stated that the facility did not perform antibiotic time outs or reviews 48 to 72 hours after initiating an antibiotic, as required by the CDC.
Failure to Provide Ordered Wound Care and Enhanced Barrier Precautions
Penalty
Summary
The facility failed to provide appropriate treatment and services for a resident with skin impairments and failed to ensure Enhanced Barrier Precautions were in place related to the resident’s wounds. The resident was admitted in December 2023 with diagnoses including stroke and was observed with two lower-leg dressings in place during surveyor observation. The left lower-leg dressing was dated 2/6, was initialed by an RN, and was noted to be soiled with bloody drainage, while the right lower-leg dressing was dated 2/13 and had no initials indicating who applied it. Record review did not reveal a physician’s order for the left lower-leg dressing at the time it was observed. Staff interviews showed that the hospice nursing assistant acknowledged the dressings and said she would inform the nurse about the left dressing. The RN who served as unit manager and wound nurse stated she was unaware the resident had a wound to the left lower leg until the surveyor brought it to the facility’s attention. After that, a wound treatment order was entered to cleanse the left lower-leg wound with normal saline, apply xeroform, and cover it with a foam dressing once daily and as needed. Another RN stated she had identified the lower-leg skin impairment, cleansed it, placed a protective dressing over it, and informed the NP, but she did not enter or obtain a wound treatment order. The NP stated she was unaware of the open area and would have expected to be notified when it was discovered. For the right lower-leg skin tear, a physician’s order directed cleansing with normal saline and applying a bandage every evening. However, the February 2026 TAR documented the treatment as completed on 2/14 and 2/15, while the dressing observed on the resident was dated 2/13, indicating the wound care was not provided on those dates. In addition, the resident was not on EBP despite having lower-leg wounds. Surveyor observation found no gowns or gloves immediately near or outside the room, and staff stated they did not use a gown for personal care unless indicated. The RN confirmed the resident was not currently on EBP and should be, and the DON was unable to provide evidence that wound care, transmission-based precautions, and wound documentation were appropriately provided.
Inaccurate wound treatment documentation
Penalty
Summary
Medical records were not accurately documented for one resident with a skin impairment. The resident was admitted in December 2023 with diagnoses including stroke and had a physician order dated 2/14/2026 to cleanse a right lower leg skin tear with normal saline and apply a bandage every evening. During observation on 2/16/2026, the resident’s right lower leg dressing was dated 2/13, and the RN acknowledged it had not been changed on 2/14 or 2/15. However, the February 2026 Treatment Administration Record documented the wound treatment as completed on 2/14 and 2/15 by an LPN. The DON was unable to provide evidence that medical records were accurately documented and maintained.
Failure to Implement Bowel Protocol Leads to Hospitalization
Penalty
Summary
The facility failed to provide treatment and care in accordance with professional standards of practice for a resident who was transferred to the hospital with an ileus and fecal impaction. The resident, who was bedbound and had a history of generalized muscle weakness, obstructive and reflux uropathy, and stage 4 chronic kidney disease, did not have a bowel movement for a total of 28 shifts over a period of ten days. Despite the facility's bowel protocol and laxative list policy, which required intervention after six and nine shifts without a bowel movement, respectively, these protocols were not followed. The resident's January 2025 Medication Administration Record (MAR) showed no evidence that the bowel protocol was implemented when the resident did not have a bowel movement for six shifts. Additionally, the MAR failed to show that the laxative list policy was followed when the resident went nine shifts without a bowel movement. An order for Miralax was obtained on January 19, 2025, but the resident did not receive it until January 21, 2025, after ten shifts without a bowel movement. The resident was eventually transferred to the hospital on January 23, 2025, due to a decrease in appetite, low blood pressure, and burning in the mouth. Hospital records indicated that the resident was admitted with fecal impaction and mouth sores, and diagnostic X-rays revealed an ileus. The Director of Nursing Services acknowledged during a surveyor interview that the bowel protocol was not followed as required by the facility policy.
Failure to Provide Appropriate Catheter Care and Monitoring
Penalty
Summary
The facility failed to provide appropriate treatment and services for a resident with an indwelling catheter, leading to a deficiency. The resident was hospitalized with a urinary tract infection and acute kidney injury, and it was discovered that the indwelling catheter was improperly placed, with the balloon inflated into the prostate. The facility's records revealed that the catheter was replaced with a different size than ordered on two occasions without a physician's order, and there was no evidence that the physician was contacted regarding these changes. Additionally, the facility did not consistently monitor the resident's indwelling catheter output as ordered by the physician. The Medication Administration Record (MAR) lacked documentation of urinary output monitoring on multiple dates and shifts throughout January. During an interview, the Director of Nursing Services acknowledged that the physician's orders were not followed and that there was no documentation of urinary output on the specified dates.
Failure to Notify Physician of Resident's Edema
Penalty
Summary
The facility failed to ensure that a resident received treatment and care in accordance with professional standards of practice, specifically regarding the management of edema. The resident, who was admitted with diagnoses including acute kidney failure and cardiac arrhythmias, began experiencing pain and swelling in the legs shortly after admission. Despite the resident's complaints and the observation of edema by staff, the facility did not notify the attending physician of the change in condition until it was brought to their attention by a surveyor, seven days after the initial assessment by a nurse. The resident's medical records indicated that there was no edema upon admission, but subsequent assessments noted swelling in the ankles. Progress notes documented complaints of pain related to edema and the use of ACE bandages for non-pitting edema. However, there was no evidence that the physician was informed of these developments until a surveyor intervened. The resident's pain levels were recorded on several occasions, but there were instances where the pain was not addressed with the prescribed acetaminophen. Interviews with staff, including nurses and therapists, revealed a lack of communication regarding the resident's condition. The resident's physician confirmed that he had not been notified of the edema, which he would have expected given the change in the resident's condition. The failure to notify the physician and address the resident's pain and edema in a timely manner resulted in the resident being unable to be discharged home as planned, due to increased pain and difficulty with mobility.
Medication Administration Error in LTC Facility
Penalty
Summary
The facility failed to ensure that a resident's medication regimen was free from significant errors. A resident, who was initially admitted in June 2021 and readmitted in October 2024, was diagnosed with hypercholesterolemia and hypertension. The resident was prescribed Lipitor 20 mg daily to manage high cholesterol. On June 27, 2024, a consultant pharmacist recommended reducing the Lipitor dosage to 10 mg daily, which the physician approved with a start date of July 9, 2024. However, the July 2024 Medication Administration Record indicated that both the 20 mg and 10 mg doses of Lipitor were administered on July 9, 10, 12, and 13, 2024, resulting in the resident receiving a total of 30 mg daily instead of the prescribed 10 mg. During interviews, the LPN and the Director of Nursing Services acknowledged the error and were unable to provide evidence that the 20 mg dose was discontinued as ordered. This oversight led to the resident receiving an incorrect dosage of medication over several days.
Inadequate Infection Control Measures for Residents with MDROs
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by the mishandling of transmission-based precautions for two residents. Resident ID #13, who was readmitted with a MRSA infection, was not properly managed under contact precautions. During a wound treatment observation, a nurse failed to sanitize medical supplies and equipment after use, and the resident's room lacked the appropriate contact precautions signage. The nurse acknowledged these lapses, including not sanitizing a sit-to-stand lift used for the resident. Resident ID #260, admitted with a history of ESBL, was not placed on Enhanced Barrier Precautions (EBP) as required by the facility's policy. Despite the resident's need for assistance with activities of daily living and incontinence, staff did not implement EBP. The facility's Director of Nursing Services and Infection Preventionist confirmed that the resident was not on any precautions, contrary to the facility's policy. The surveyor's observations and staff interviews highlighted the facility's failure to adhere to its own infection control policies, resulting in inadequate precautions for residents with multidrug-resistant organisms. The deficiencies were acknowledged by the facility's Director of Nursing Services, who confirmed the lapses in maintaining appropriate infection control measures.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Westerly
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Westerly Health Center | 2 mi | ★★★★★ | 0 | 0 |
| Apple Rehab Clipper | 2.6 mi | ★★★★★ | 0 | 0 |
| Avalon Health Care Center At Stoneridge | 6.3 mi | ★★★★★ | 1 | 0 |
| Pendleton Rehabilitation And Nursing Center | 6.4 mi | ★★★★★ | 1 | 0 |
| Apple Rehab Mystic | 7 mi | ★★★★★ | 5 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.