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Royal of Westerly Nursing Center
Nursing Home, Hospice Care, Memory Care, Palliative Care, Respite Care & Skilled Nursing · Westerly, RI
CMS overall rating Info CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
Royal of Westerly Nursing Center, Nursing Home in Westerly, RI — A resident enjoying a meal in their room

Royal of Westerly Nursing Center

Nursing Home, Hospice Care, Memory Care, Palliative Care, Respite Care & Skilled Nursing · Westerly, RI
CMS overall rating Info CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
79 Beach Street, Westerly, RI 02891 View map Calculator: See prices in your area
Royal of Westerly Nursing Center accepts Medicare, Medicaid, and private pay.
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Royal of Westerly Nursing Center accepts Medicare, Medicaid, and private pay.

Overview of Royal of Westerly Nursing Center

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Located on Beach Street in Westerly, Rhode Island, Royal of Westerly Nursing Center is a skilled nursing home owned by Susan Misto. The 66-bed facility has been operating for 9 years. It serves residents needing short-term rehabilitation as well as longer-term nursing care.

Medicare, Medicaid, and private pay are accepted, giving families several options for covering care costs. The home has an occupancy rate of 89%. Residents stay an average of 120 days, including a mix of post-acute recovery stays and ongoing residential care.

Daily nurse staffing averages 3 hours and 26 minutes per resident. Registered nurses provide 52 minutes of direct care each day, while nurse aides contribute 1 hour and 44 minutes. With this level of staffing, the facility can work on its rehabilitation focus and provide care for residents with higher-acuity needs. Short-term rehabilitation, respite care, and 24-hour staffing are all part of the care program.

Specialized services include Alzheimer’s care, cardiac care, nutritional support, and activity enrichment programs. The facility also offers the Russian “Sunrise” Immersion Program and the Royal at Home program. These programs support cultural connection and continuity of care while adding to the daily experience of residents and families.

The facility is located in a car-dependent area with a Walk Score of 19. Most errands and outings require transportation. Its beachside community setting is close to the ocean. Families can expect a quieter pace in a New England coastal town.

State inspections identified concerns related to medication administration and quality procedures. The facility responded with corrective plans, and a later review confirmed that compliance had been restored.

Facility Direct Line (401) 596-4925
Facility Direct Line (401) 596-4925
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Quality ratings

Measured by Centers for Medicare & Medicaid Services (CMS)

Overall rating Info The Overall CMS Rating combines results from health inspections, staffing levels and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
▲ 30.3% Above RI avg. ▲ 30.3% Above RI avg.RI average: 3.1Click the badge to see the full State ranking.Click here to see the full State ranking.
Health Inspection Info Based on the results of the facility's three most recent standard inspections and any complaint investigations. CMS reviews the number, scope, and severity of deficiencies, with more recent findings weighted more heavily.
▲ 37.8% Above RI avg. ▲ 37.8% Above RI avg.RI average: 2.9Click the badge to see the full State ranking.Click here to see the full State ranking.
Staffing Info Measures average nursing staff hours per resident per day, including Registered Nurses (RNs) and total nursing staff. Ratings are adjusted based on the level of care residents require and are compared to state and national benchmarks.
▼ 13.3% Below RI avg. ▼ 13.3% Below RI avg.RI average: 3.5Click the badge to see the full State ranking.Click here to see the full State ranking.
Quality Measures Info Based on clinical and physical health indicators reported to CMS, such as hospital readmissions, falls, pressure ulcers, and improvements in mobility. These measures reflect how well residents' health needs are being managed.
▼ 6.9% Below RI avg. ▼ 6.9% Below RI avg.RI average: 3.2Click the badge to see the full State ranking.Click here to see the full State ranking.

Staffing hours Info Daily nursing hours per resident by staff type, reported to CMS. Higher is generally better — compare this facility to state and national averages to see where staffing stands.

Hours per resident per day vs Rhode Island averages

Rank #46 / 55Nurse hours — State benchmarkedThis home is ranked 46th out of 55 homes we track in Rhode Island for nurse hours. Shows adjusted nurse hours per resident per day benchmarked to the Rhode Island average, with a ranking across 55 Rhode Island facilities. More hours mean more direct care. The national average is about 3.5 hrs; below 3.0 is a red flag.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.

Total nursing care Info This home is ranked 46th out of 55 homes we track in Rhode Island for nurse hours. Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.

3h 12m

20% below state avg
Staff type
Hours / day / resident
vs state avg
Registered Nurse (RN) Info RNs hold the highest nursing license and can assess residents, interpret test results, and direct care plans. More RN hours per day often signals stronger clinical oversight and faster response to health changes.
51m
+12% State avg: 46m per day · National avg: 41m per day
LPN / LVN Info Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) deliver routine hands-on care — medication administration, wound dressing, and monitoring vital signs. They work under RN supervision and make up a large share of daily bedside care.
41m
+42% State avg: 29m per day · National avg: 52m per day
Nurse Aide Info Certified Nurse Aides (CNAs) provide the most direct day-to-day assistance: bathing, dressing, feeding, and mobility. Nurse aide hours are typically the largest staffing category and directly affect residents' quality of life.
1h 40m
−33% State avg: 2h 28m per day · National avg: 2h 20m per day
Weekend Total Nursing Info Combined nursing hours (RN + LPN + Nurse Aide) per resident per day on weekends. Staffing often drops on weekends — this figure reveals whether the facility maintains adequate coverage outside of weekday hours.
2h 45m
−17% State avg: 3h 18m per day · National avg: 3h 26m per day
Physical Therapist Info Hours per resident per day provided by licensed Physical Therapists (PTs) or PT Assistants. PT services help residents recover mobility after injury or illness and are especially important for post-acute (short-stay) rehabilitation.
3m
+6% State avg: 3m per day · National avg: 4m per day
Weekend RN Info Registered nurse hours specifically on weekends. Facilities sometimes reduce RN presence on Saturdays and Sundays — a low weekend RN figure compared to weekday hours can indicate reduced clinical oversight when most administrative staff are absent.
33m
−4% State avg: 34m per day · National avg: 28m per day

3 of 6 metrics below state avg

Standout metric: LPN / LVN is +42% above Rhode Island average

By The Numbers

Community insights.

Bed count Info A smaller, more intimate setting that may offer a quieter environment and closer staff-resident interactions. 66 Rank #52 / 66Bed count — State benchmarkedThis home is ranked 52nd out of 66 homes we track in Rhode Island for bed count. Shows this facility's certified or reported bed count compared to other Rhode Island facilities. Larger communities may offer more amenities, programs, and on-site services for residents and families.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.

Smaller home · May offer a more intimate, personalized care environment.

Years of operating Info A community with a solid operating history and experience delivering ongoing care. This is the number of years in operation under current management. Rank #24 / 47Years in operation — State benchmarkedThis home is ranked 24th out of 47 homes we track in Rhode Island for years in operation. Shows how long this facility has been in operation compared to other Rhode Island facilities. Longer operating histories may benefit residents, families, and staff.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
10 years
Walk Score Info Car-dependent. Most errands require a car, with limited nearby walkable options. Rank #53 / 65Walk Score — State benchmarkedThis home is ranked 53rd out of 65 homes we track in Rhode Island for walk score. Shows how walkable this facility's neighborhood is compared to the average walk score across Rhode Island facilities. Higher scores benefit residents, families, and staff.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
19 / 100
Occupancy rate Info Occupancy between 85% and 95% suggests balanced demand. Rank #21 / 51Occupancy rate — State benchmarkedThis home is ranked 21st out of 51 homes we track in Rhode Island for occupancy. Shows this facility's occupancy rate versus the Rhode Island average, with its Statewide rank out of 51. Higher occupancy signals strong local demand and financial stability.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
89.4% This home usually has limited availability
Higher than the Rhode Island average: 83.8%
Occupied beds
59 / 66
Avg. Length of Stay Info Average number of days residents stay at this facility, based on CMS cost report data. Shorter stays often reflect post-acute or rehab care; longer stays reflect long-term care.
120 days

About this community

License Details

Facility TypeNursing Facility
StatusActive
IssuanceJuly 1, 2016
License NumberLTC00801
CMS Certification Number415004

Ownership & Operating Entity

Owner NameAdministrator Susan Misto

Therapy & Rehabilitation

3 services
Rehabilitation Services
Respite Care
Short-Term Rehab

Staffing & Medical

1 service
24-Hour Staffing

Contact Information

Fax(401) 596-4925

Additional Policies & Features

Pets not allowed

Amenities & Lifestyle

Specific ProgramsActivity Enrichment, Alzheimer’s Care, Cardiac Care, Nutritional Care, Royal at Home, Russian “Sunrise” Immersion Program

Contact Royal of Westerly Nursing Center

CMS Health Inspection History

ALM Inspection Grade Unavailable

Not published

We don't have enough verified data to publish an inspection grade for this facility — a missing grade reflects what we've been able to verify, not the facility's quality.

ALM Inspection Grade unavailable: limited inspection data.
Inspections Since 2023 · 3 years of data

Includes all CMS health inspection records for this property, which could include management/ownership changes.

Total health inspections 5

State average 8.4

Last Health inspection on Feb 2026

Total health citations
19 Rank #9 / 57Health citations — State benchmarkedThis home is ranked 9th out of 57 homes we track in Rhode Island for health citations. Shows this facility's total health deficiency citations benchmarked to the Rhode Island State average, with a ranking across all 57 RI facilities. Lower citation counts earn a better rank.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.

State average 28.1

Citations per inspection
3.8 Rank #4 / 57Citations per inspection — State benchmarkedThis home is ranked 4th out of 57 homes we track in Rhode Island for citations per inspection. Shows average deficiency citations per CMS inspection for this facility versus the Rhode Island mean across 57 facilities with citation data. Lower is better.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.

State average 3.42

Health citations are formal notices following inspections when they fail to comply with safety and care standards.

16 of 19 citations resulted from standard inspections; and 3 of 19 resulted from complaint investigations.

Breakdown of citation severity (last 3 years)
Critical health citations
0
100% better than State average

State average: 1.5

Serious health citations
1
38% better than State average

State average: 1.6

0 critical citations State average: 1.5
1 serious citation State average: 1.6
17 moderate citations State average: 24.4
1 minor citation State average: 0.6
Citations history (last 3 years)
Infection Control moderate citation Feb 19, 2026
Corrected
Nursing Services moderate citation Feb 19, 2026
Corrected
Pharmacy moderate citation Feb 19, 2026
Corrected
Pharmacy moderate citation Feb 19, 2026
Corrected

Data sourced from CMS Health Deficiencies reports. Citation severity codes range from A (least serious) to L (most serious). Immediate Jeopardy (J-L) citations indicate situations where the facility's noncompliance has placed residents at risk of death or serious harm.

Show Inspection Reports

Staffing Data

Reporting period: October 1 – December 31, 2025 (Q4 2025). Source: CMS Payroll-Based Journal report.

Total staff 100
Employees 88
Contractors 12
Staff to resident ratio 1.69 : 1
8% fewer staff per resident than Rhode Island average
Rhode Island average ratio: 1.85 : 1 Rhode Island average ratio: 1.85 : 1See full Rhode Island ranking
Avg staff/day 35
Average shift 6.9 hours
9% worse than Rhode Island average
Rhode Island average: 7.6 hours Rhode Island average shift: 7.6 hoursSee full Rhode Island ranking
Total staff hours (quarter) 22,196

Nursing staff breakdown

Q4 2025 · Oct 1 – Dec 31 More info This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Registered Nurse

Manages medical care and health needs.

RN Staff Info All 14 RN Staff are full-time employees. No contractors work on this role. 14
Average shift length Info Average shift length. Calculated as total hours divided by days worked and average staff per day. 7.7 hours
Licensed Practical Nurse

Assists with medical care and medications.

LPN Staff Info All 10 LPN Staff are full-time employees. No contractors work on this role. 10
Average shift length Info Average shift length. Calculated as total hours divided by days worked and average staff per day. 8.4 hours
Certified Nursing Assistant

Helps with daily care and mobility.

CNA Staff Info All 36 CNA Staff are full-time employees. No contractors work on this role. 36
Average shift length Info Average shift length. Calculated as total hours divided by days worked and average staff per day. 7.3 hours

Contractor staffing

Q4 2025 · Oct 1 – Dec 31 More info This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.

Total hours from contractors

8.5%

1,891 contractor hours this quarter

Physical Therapy Aide: 3 Physical Therapy Assistant: 3 Speech Language Pathologist: 2 Respiratory Therapy Technician: 2 Qualified Social Worker: 2

Staff by category

Q4 2025 · Oct 1 – Dec 31 More info This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Certified Nursing Assistant360368,47692100%7.3
Licensed Practical Nurse100103,49892100%8.4
Registered Nurse140142,97392100%7.7
Clinical Nurse Specialist7071,4698188%3.9
Nurse Aide in Training5057736975%7.1
Administrator2025746267%6.3
Physical Therapy Assistant0335006975%6.6
Other Dietary Services Staff2024766065%7
Mental Health Service Worker1014685964%7.9
Dietitian1014666470%7.3
Speech Language Pathologist0224596470%7.2
Nurse Practitioner1014495762%7.9
Medication Aide/Technician5054044751%6.5
Physical Therapy Aide0333726267%5.9
Respiratory Therapy Technician0223185459%5.8
Qualified Social Worker0222433942%6.2
Occupational Therapy Aide1011622527%6.5
Feeding Assistant101551112%5
Medical Director101361213%3
Occupational Therapy Assistant1012933%9.5
36 Certified Nursing Assistant
% of Days 100%
10 Licensed Practical Nurse
% of Days 100%
14 Registered Nurse
% of Days 100%
7 Clinical Nurse Specialist
% of Days 88%
View All Staffing Data

Penalties and fines

Includes penalties issued in 2025

Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.

Source: CMS Penalties Database (Data as of Jan 2026)

Total fines amount $9K Rank #19 / 57Federal fines — State benchmarkedThis home is ranked 19th out of 57 homes we track in Rhode Island for federal fines. Shows this facility's cumulative CMS federal fine dollars versus the Rhode Island average among facilities with fines, and where it ranks among 57 facilities in the pool. Lower total dollars mean a better rank.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
91% lower than Rhode Island average

Rhode Island average: $94K

Number of fines 1
65% fewer fines than Rhode Island average

Rhode Island average: 2.8

Payment Denials Info Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed. 0
100% fewer payment denials than Rhode Island average

Rhode Island average: 0.4

Fines amount comparison
Fines amount comparison
This facility $9K
Rhode Island average $94K
Penalty History

Penalties are imposed by CMS for violations of federal nursing home regulations.

1 penalty in the past 3 years

Feb 4, 2025 · $9K

Civil Money Penalty Info Fines imposed for noncompliance, which can be assessed per day or per instance of violation. Feb 4, 2025
$9K

Last updated: Jan 2026

Quality of care over time

These measures show how residents usually do over time at this home, based on health outcomes and preventive care.

High-risk clinical events score Info A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline. 9.4
9% better than Rhode Island average

Rhode Island average: 10.3

Functional decline score Info A composite score based on activities of daily living decline, walking ability decline, and incontinence. 21.9
8% worse than Rhode Island average

Rhode Island average: 20.2

Long-stay resident measures
Below average Rhode Island avg: 3.2 Info CMS star rating based on long-stay quality measure performance. 5 stars = significantly above average, 1 star = significantly below average.
Need for Help with Daily Activities Increased Info Percent of long-stay residents whose need for help with daily activities has increased 19.0%
In line with Rhode Island average

Rhode Island average: 19.5%

Walking Ability Worsened Info Percent of long-stay residents whose ability to move independently worsened 16.7%
8% better than Rhode Island average

Rhode Island average: 18.2%

Low Risk Residents with Bowel/Bladder Incontinence Info Percent of low risk long-stay residents who lose control of their bowels or bladder 30.0%
31% worse than Rhode Island average

Rhode Island average: 22.9%

Falls with Major Injury Info Percent of long-stay residents experiencing one or more falls with major injury 4.9%
33% worse than Rhode Island average

Rhode Island average: 3.7%

High Risk Residents with Pressure Ulcers Info Percent of long-stay high risk residents with pressure ulcers 2.6%
45% better than Rhode Island average

Rhode Island average: 4.7%

Urinary Tract Infection Info Percent of long-stay residents with a urinary tract infection 1.0%
56% better than Rhode Island average

Rhode Island average: 2.3%

Lost Too Much Weight Info Percent of long-stay residents who lose too much weight 3.7%
32% better than Rhode Island average

Rhode Island average: 5.4%

Depressive Symptoms Info Percent of long-stay residents who have depressive symptoms 44.0%
227% worse than Rhode Island average

Rhode Island average: 13.5%

Antipsychotic Use Info Percent of long-stay residents who received an antipsychotic medication 18.5%
14% better than Rhode Island average

Rhode Island average: 21.5%

Pneumococcal Vaccine Info Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine 99.5%
7% better than Rhode Island average

Rhode Island average: 93.1%

Influenza Vaccine Info Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine 100.0%
5% better than Rhode Island average

Rhode Island average: 95.3%

Hospitalizations per 1,000 days Info Number of hospitalizations per 1,000 long-stay resident days. 1.54
5% worse than Rhode Island average

Rhode Island average: 1.46

ED visits per 1,000 days Info Number of outpatient emergency department visits per 1,000 long-stay resident days. 1.62
6% better than Rhode Island average

Rhode Island average: 1.72

Short-stay resident measures
Above average Rhode Island avg: 2.4 Info CMS star rating based on short-stay quality measure performance. 5 stars = much above average, 1 star = much below average.
Pneumococcal Vaccine Info Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine 83.6%
10% better than Rhode Island average

Rhode Island average: 76.2%

Antipsychotic medication increase Info Percent of short-stay residents who newly received an antipsychotic medication 0.4%
79% better than Rhode Island average

Rhode Island average: 2.0%

Influenza Vaccine Info Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine 95.7%
22% better than Rhode Island average

Rhode Island average: 78.2%

Re-hospitalized after SNF stay Info Percentage of short-stay residents who were re-hospitalized after their nursing home admission. 25.3%
In line with Rhode Island average

Rhode Island average: 25.1%

Emergency department visits Info Percentage of short-stay residents who had an outpatient emergency department visit. 16.1%
In line with Rhode Island average

Rhode Island average: 15.8%

Falls with major injury Info Percentage of SNF residents who experience falls with major injury during their stay. 0.0%
100% better than Rhode Island average

Rhode Island average: 0.8%

Ability to care for self at discharge Info Percentage of residents at or above expected ability to care for themselves at discharge. 68.8%
28% better than Rhode Island average

Rhode Island average: 53.7%

Successful return to home or community Info Rate of successful return to home or community from a skilled nursing facility. 71.0%
40% better than Rhode Island average

Rhode Island average: 50.6%

Quality measures are calculated from Minimum Data Set (MDS) assessments. For most measures, lower percentages indicate better care quality.

Breakdown by payment type

Medicare

41% of new residents, usually for short-term rehab.

Typical stay 1 - 2 months

Private pay

56% of new residents, often for short stays.

Typical stay 3 - 4 months

Medicaid

3% of new residents, often for long-term daily care.

Typical stay 4 years

Facility Characteristics

Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)

Total residents 59
Medicare
5
8.5% of residents
Medicaid
26
44.1% of residents
Private pay or other
28
47.5% of residents
Programs & Services
Residents Group

Residents meet regularly to discuss policies, care quality, and activities

Active Resident Council

Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.

Data sourced from CMS Long-Term Care Facility Characteristics quarterly report. Payer mix reflects the current resident census by primary payment source.

Finances and operations

Based on CMS SNF Cost Report for fiscal year ending in 12/2023.

For-profit
Operated by a partnership between two or more business owners.
Net patient revenue Info Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
$7.7M
Net patient income Info Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
$348.0K
For-profit Operated by a partnership between two or more business owners.
Net patient revenue Info Net patient revenue — what the home actually collects for resident care, after contractual allowances, bad debt and discounts are subtracted from its gross charges (CMS cost report, Worksheet G-3). It covers resident care only; money the home earns from other sources is shown separately as "Other income."
$7.7M Rank #41 / 55Net patient revenue — State benchmarkedThis home is ranked 41st out of 55 homes we track in Rhode Island. Shows this facility's net patient revenue compared to the Rhode Island average, among facilities reporting a recent fiscal year. Higher revenue generally means more resources for staffing and capital — read alongside Payroll %.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.
Net patient income Info Net patient income: net patient revenue minus the home's total operating expenses. A positive figure means it earns more from resident care than it spends to deliver it; a negative figure means the opposite. It excludes non-operating "other income."
$348.0K
Other income Info Money the home earns outside of resident care — such as investments, grants, rentals and other non-operating sources (CMS cost report, Worksheet G-3). It is tracked separately from net patient revenue: it is not part of that figure, and it is not included in net patient income.
$60.1K
Payroll costs Info Staff salaries plus wage-related costs — benefits such as payroll taxes, health insurance and retirement — from the home's own accounting records (CMS cost report, Worksheet A). Contract or agency labor is counted separately, under other operating costs. Rank #47 / 55Payroll costs — State benchmarkedThis home is ranked 47th out of 55 homes we track in Rhode Island. Shows total staff payroll — salaries plus wage-related benefits — benchmarked to the Rhode Island average, among facilities reporting a recent fiscal year. Higher payroll relative to peers often signals better staffing and less reliance on contract labor.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.
$4.2M 55% of net patient revenue Info Payroll as a share of revenue: staff salaries and wage-related benefits divided by net patient revenue. A higher figure means more of each revenue dollar goes to staff pay. Rank #38 / 55Payroll % of net patient revenue — State benchmarkedThis home is ranked 38th out of 55 homes we track in Rhode Island. Shows payroll as a percentage of net patient revenue versus the Rhode Island average, among facilities reporting a recent fiscal year. Below 25% may signal understaffing or heavy agency use — read with Staffing ratings.Communities with the same value for a metric share the same rank. Rankings cover every community we track in Rhode Island that reports data for that category. Communities without available data are excluded, so the pool size varies from metric to metric.
Other operating costs Info Everything it costs to run the home apart from payroll — food, utilities, supplies, maintenance, contract labor and administration. Calculated as total operating expense minus payroll (staff salaries and wage-related benefits).
$3.1M
Total costs Info The home's total operating expense for the year — all the costs of running it, salaries included (CMS cost report, Worksheet G-3).
$7.3M
How we calculate these figures

This home is owned by Administrator Susan Misto

Certified by the Centers for Medicare & Medicaid Services authority — CMS Certification Number: 415004

Show certification details

Who this home usually serves

TYPE OF STAY

Mix of rehab and long-term care

This home supports both short-term rehab and long-term care, with residents staying for a wide range of durations.

Most new residents arrive under private pay (56% of admissions), and a typical private pay stay runs around 3 - 4 months.

Admissions
192 total

Coverage residents most often arrive under.

Medicare 41%
Private pay 56%
Medicaid 3%
Discharges
184 total

Coverage residents most often leave under.

Medicare 34%
Private pay 55%
Medicaid 11%

Admissions and discharges reflect care patterns over time — they are not used to rate this facility.

How we assess these insights

Places of interest near Royal of Westerly Nursing Center

Address 2.3 miles from city center Info Estimated distance in miles from Westerly's city center to Royal of Westerly Nursing Center's address, calculated via Google Maps.

Calculate Travel Distance to Royal of Westerly Nursing Center

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Compare Nursing Homes around the area

Info below is compiled from CMS reports & the RI Dept. of Health (RIDOH), senior community websites & trusted data sources such as Walk Score & BBB.

Communities are listed from highest-ranked to lowest-ranked based on our methodology.

The facility name. Click to view the full profile page on Assisted Living Magazine, including photos, services, and contact info.
CMS (Centers for Medicare & Medicaid Services, the federal agency that regulates nursing homes) Overall 5-star rating — a composite of Health Inspection, Staffing, and Quality Measures scores. 5 stars = top 10% nationally. 1 star = bottom 10%. The single most important number to start with when comparing facilities.
Care Types in This Table AL (Assisted Living): Housing with help for daily activities like bathing, dressing, and medication, without 24-hour skilled nursing. NH (Nursing Home): 24/7 skilled nursing care for residents with complex, ongoing medical needs. SNF (Skilled Nursing Facility): Round-the-clock nursing care, often for recovery after surgery, injury, or illness. MC (Memory Care): Secured, specialized care for people living with Alzheimer's or dementia. RC (Respite Care): Short-term temporary care that gives family caregivers a break. IL (Independent Living): Community living with dining, activities, and transportation for active seniors who need little personal care. HOS (Hospice Care): Comfort-focused care for those with a terminal illness, prioritizing quality of life over treatment. PC (Palliative Care): Comfort-focused care for serious illness at any stage, including alongside curative treatment.
Neighborhood or city area where the facility is located. Proximity to family, hospitals, and green space matters for both quality of life and ease of visitation. Consider drive time and transit access when evaluating location.
Licensed bed capacity. Larger facilities (300+ beds) often have more specialized programs but can feel institutional. Smaller homes (under 150 beds) tend to deliver more personalized care. Compare with Avg Res/Day to understand how full the facility typically runs.
Percentage of licensed beds filled on an average day. Color indicates financial health: green (90%+) = operationally strong, typically profitable. Amber (80–89%) = stable but leaving revenue on the table. Orange (70–79%) = financial strain likely, may struggle with fixed costs. Red (<70%) = significant distress, closure or ownership change risk increases sharply.
This facility's occupancy rate compared to the statewide average for similar facilities. A positive number means above-average demand. Facilities running 5%+ above the state average are typically the most sought-after in their market — a strong proxy for reputation.
CMS-adjusted total nurse hours per resident per day (RN + LPN + CNA combined). The national average is approximately 3.5 hrs. Higher is better — more direct care time per resident. Below 3.0 is a red flag. CMS weights RN hours more heavily because RNs handle complex clinical decisions that CNAs cannot.
CMS Health Inspection star rating (1–5 stars), based on the 3 most recent annual state surveys plus any complaint investigations. This is the hardest rating to manipulate — it reflects real surveyor findings on-site. 5 stars = fewest deficiencies found. 1 star = most. It carries the heaviest weight in the Overall CMS rating.
CMS Staffing star rating (1–5 stars), based on daily nurse staffing hours submitted to CMS via verified payroll data. Compares RN, LPN, and CNA coverage relative to resident acuity level. 5 stars = well above expected staffing. Weekend staffing is evaluated separately, as that's where many facilities quietly reduce coverage.
CMS Quality Measures star rating (1–5 stars), based on 15 clinical outcome metrics including fall rates, pressure ulcers, antipsychotic drug use, and hospital readmissions. Captures actual resident health outcomes, not just compliance. High QM combined with low Health Inspection scores can indicate a facility with strong care but weak documentation practices.
Registered Nurse hours per resident/day compared to the statewide average. RNs are the highest-skilled nursing staff — they assess residents, manage medications, and respond to emergencies. A value of +50% means RN coverage is 50% above the state norm. Negative values are a concern for residents with complex or acute medical needs.
Total nursing staff hours (RN + LPN + CNA combined) per resident/day vs. the statewide average. A broader measure than RN vs State — it captures the entire care team. A facility can have high total staffing but low RN hours, meaning more aides and fewer nurses. Read both columns together for the full picture.
Total dollar amount of federal monetary fines (civil money penalties) issued by CMS in the past 3 years. Fines are only levied for serious violations — typically actual harm to residents, repeated uncorrected deficiencies, or systemic non-compliance. Even a single fine is noteworthy. Multiple fines strongly suggest a pattern, not isolated incidents.
Total health deficiency citations from the most recent standard inspection cycle. Minor citations (scope A–C) are common and often administrative in nature. Higher counts aren't always disqualifying, but should be read alongside Severe Citations to understand actual harm levels. Under 10 is strong for a large facility; 30+ warrants a closer look.
Average deficiency citations per CMS inspection (survey) in the reporting window — total citations divided by the number of inspections. Lower is better; compare alongside total Citations and Severe Citations for context.
Citations at CMS scope/severity level G or higher — G–I means actual harm occurred; J–L means residents were placed in immediate jeopardy. (D–F is potential for harm only). Examples include unaddressed falls, medication errors causing injury, neglect, or abuse.
Average number of residents in the building on any given day, derived from annual census data. Reflects true operating scale — a 400-bed facility running 200 residents/day operates very differently from one at 390. Higher resident counts generally mean more funded staffing hours.
Better Business Bureau rating (A+ to F). Reflects complaint history, business transparency, and how family disputes were resolved. A+ means no significant unresolved complaints. A blank (—) means the facility isn't BBB-accredited, which is common for healthcare providers and not necessarily a negative signal.
Walk Score® (0–100). Measures walkability of the surrounding area. 90–100 = Walker's Paradise. 70–89 = Very Walkable. 50–69 = Somewhat Walkable. Below 50 = Car-Dependent. Higher scores benefit family visitors, resident outings, and staff commuting.
The licensed owner or operator of record filed with CMS — the individual or organization legally accountable for the facility. Searching the operator name across other facilities can reveal chain or multi-site ownership, which matters: chain-operated homes tend to have more variable quality outcomes than independently run facilities.
What the home actually collects for resident care, after contractual allowances, bad debt and discounts — not gross billings. Taken from the latest complete annual cost report, so it is comparable across homes reporting the same period. Revenue alone doesn't indicate care quality, but it funds staffing and capital reinvestment. Pair with Payroll %. Figures are from each facility's most recent complete fiscal year — hover a value for the exact year; a * marks homes that report an older period than most facilities.
Staff salaries plus wage-related benefits from the latest complete annual cost report. Contract and agency labour is counted separately, under other operating costs, so a home leaning on agency staff can show a low figure here. Payroll is the cost most directly tied to care quality — compare with Payroll % for full context. Figures are from each facility's most recent complete fiscal year — hover a value for the exact year; a * marks homes that report an older period than most facilities.
Payroll as a share of NET PATIENT REVENUE (not gross revenue). Both figures come from the same cost-report year. A higher figure means more of each revenue dollar goes to staff pay. Read with the Staffing star rating to judge whether spend translates into coverage — and note that homes whose patient revenue covers only part of their operation can read implausibly high. The Rhode Island average is: 64.3% Figures are from each facility's most recent complete fiscal year — hover a value for the exact year; a * marks homes that report an older period than most facilities.
CMS Certification Number: the unique federal identifier for this skilled nursing provider.
Briarcliffe Manor ★ ★ ★ ★ ★
NH
AL
IL
MC
RC
SNF
Johnston
122
Facility 122
RI AVG 109
Rank #26 / 66
91.0%
Facility 91.0%
RI AVG 83.8%
Rank #17 / 51
+9%
5.19
Facility 5.19
RI AVG 4.01
Rank #3 / 55
 ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ -28%+29%
$0
Facility $0
RI AVG $97.5k
Rank #1 / 57
5
Facility 5
RI AVG 28.1
Rank #3 / 57
2.5
Facility 2.5
RI AVG 3.5
Rank #7 / 57
-111A+
38
Facility 38
RI AVG 49
Rank #38 / 65
Adm Akshay K. Talwar
$12.5MFiscal year ending 12/2023
Facility $12.5MFiscal year ending 12/2023
RI AVG $11.4M
Rank #21 / 55
$10.0MFiscal year ending 12/2023
Facility $10.0MFiscal year ending 12/2023
RI AVG $7.0M
Rank #8 / 55
79.7%Fiscal year ending 12/2023
Facility 79.7%Fiscal year ending 12/2023
RI AVG 64.3%
Rank #10 / 55
415012
John Clarke Senior Living ★ ★ ★ ★ ☆
NH
IL
MC
RC
SNF
Middletown (Newport East)
60
Facility 60
RI AVG 109
Rank #56 / 66
91.7%
Facility 91.7%
RI AVG 83.8%
Rank #15 / 51
+9%
3.57
Facility 3.57
RI AVG 4.01
Rank #30 / 55
 ★ ★ ★ ★ ☆ ★ ★ ★ ★ ☆ ★ ★ ★ ★ ☆ +30%-11%
$0
Facility $0
RI AVG $97.5k
Rank #1 / 57
4
Facility 4
RI AVG 28.1
Rank #2 / 57
1.3
Facility 1.3
RI AVG 3.5
Rank #1 / 57
155-
34
Facility 34
RI AVG 49
Rank #41 / 65
Joan M. Woods
$6.7MFiscal year ending 12/2023
Facility $6.7MFiscal year ending 12/2023
RI AVG $11.4M
Rank #48 / 55
$4.7MFiscal year ending 12/2023
Facility $4.7MFiscal year ending 12/2023
RI AVG $7.0M
Rank #43 / 55
69.6%Fiscal year ending 12/2023
Facility 69.6%Fiscal year ending 12/2023
RI AVG 64.3%
Rank #22 / 55
415076
Royal of Westerly Nursing Center ★ ★ ★ ★ ☆
NH
HOS
MC
PC
RC
SNF
Westerly
66
Facility 66
RI AVG 109
Rank #52 / 66
89.4%
Facility 89.4%
RI AVG 83.8%
Rank #21 / 51
+7%
3.20
Facility 3.20
RI AVG 4.01
Rank #46 / 55
 ★ ★ ★ ★ ☆ ★ ★ ★ ☆ ☆ ★ ★ ★ ☆ ☆ +3%-20%
$8.6k
Facility $8.6k
RI AVG $97.5k
Rank #19 / 57
19
Facility 19
RI AVG 28.1
Rank #9 / 57
3.8
Facility 3.8
RI AVG 3.5
Rank #4 / 57
159-
19
Facility 19
RI AVG 49
Rank #53 / 65
Administrator Susan Misto
$7.7MFiscal year ending 12/2023
Facility $7.7MFiscal year ending 12/2023
RI AVG $11.4M
Rank #41 / 55
$4.2MFiscal year ending 12/2023
Facility $4.2MFiscal year ending 12/2023
RI AVG $7.0M
Rank #47 / 55
55%Fiscal year ending 12/2023
Facility 55%Fiscal year ending 12/2023
RI AVG 64.3%
Rank #38 / 55
415004
Overlook Nursing and Rehabilitation Center ★ ★ ★ ☆ ☆
NH
HOS
MC
PC
RC
SNF
Pascoag
100
Facility 100
RI AVG 109
Rank #35 / 66
89.0%
Facility 89.0%
RI AVG 83.8%
Rank #23 / 51
+6%
3.67
Facility 3.67
RI AVG 4.01
Rank #27 / 55
 ★ ★ ★ ☆ ☆ ★ ★ ★ ★ ☆ ★ ★ ☆ ☆ ☆ +2%-9%
$10.4k
Facility $10.4k
RI AVG $97.5k
Rank #21 / 57
23
Facility 23
RI AVG 28.1
Rank #19 / 57
4.6
Facility 4.6
RI AVG 3.5
Rank #56 / 57
189-
53
Facility 53
RI AVG 49
Rank #34 / 65
Administrator Lori Pendleton
$9.4MFiscal year ending 12/2023
Facility $9.4MFiscal year ending 12/2023
RI AVG $11.4M
Rank #35 / 55
$5.8MFiscal year ending 12/2023
Facility $5.8MFiscal year ending 12/2023
RI AVG $7.0M
Rank #35 / 55
61.9%Fiscal year ending 12/2023
Facility 61.9%Fiscal year ending 12/2023
RI AVG 64.3%
Rank #30 / 55
415045
Friendly Home ★ ☆ ☆ ☆ ☆
NH
HOS
MC
SNF
Woonsocket
126
Facility 126
RI AVG 109
Rank #25 / 66
88.1%
Facility 88.1%
RI AVG 83.8%
Rank #25 / 51
+5%
3.70
Facility 3.70
RI AVG 4.01
Rank #27 / 55
 ★ ☆ ☆ ☆ ☆ ★ ★ ★ ☆ ☆ ★ ★ ☆ ☆ ☆ -8%-8%
$107.7k
Facility $107.7k
RI AVG $97.5k
Rank #34 / 57
38
Facility 38
RI AVG 28.1
Rank #33 / 57
4.2
Facility 4.2
RI AVG 3.5
Rank #12 / 57
6111A+
24
Facility 24
RI AVG 49
Rank #49 / 65
Cheryl Picard$12.4M*Fiscal year ending 01/2022These figures are from this home's most recent complete cost report — an older period than most facilities report. Compare with that in mind.$7.6M*Fiscal year ending 01/2022These figures are from this home's most recent complete cost report — an older period than most facilities report. Compare with that in mind.61.2%*Fiscal year ending 01/2022These figures are from this home's most recent complete cost report — an older period than most facilities report. Compare with that in mind.415044

Rank badges are statewide: each nursing home is ranked against every RI nursing home we track that reports that metric, not just the 5 on this page. See how we rank facilities

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Frequently Asked Questions about Royal of Westerly Nursing Center

Who is the owner of Royal of Westerly Nursing Center?

Royal of Westerly Nursing Center is legally operated by Susan Misto, Administrator.

Is Royal of Westerly Nursing Center in a walkable area?

Royal of Westerly Nursing Center has a walk score of 19. Car-dependent. Most errands require a car, with limited nearby walkable options.

What is the license number of Royal of Westerly Nursing Center?

According to RI state health department records, Royal of Westerly Nursing Center's license number is LTC00801.

What is the occupancy rate at Royal of Westerly Nursing Center?

Royal of Westerly Nursing Center's occupancy is 89.4%.

How long has Royal of Westerly Nursing Center been in business?

Royal of Westerly Nursing Center has been operating for approximately 10 years, based on available licensing and registration records.

Are pets allowed at Royal of Westerly Nursing Center?

No, Royal of Westerly Nursing Center has a no-pet policy.

Does Royal of Westerly Nursing Center operate as a for-profit or non-profit?

Royal of Westerly Nursing Center is registered as a for-profit in RI.

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