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Complaint Investigation

Clover Health Care

Inspection Date: August 13, 2025
Total Violations 3
Facility ID 205063
Location AUBURN, ME
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Inspection Findings

F-Tag F0656

Resident Assessment and Care Planning Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0656

after Resident #1's fall, and stated administration identified that staff were not following care plans.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Clover Health Care

440 Minot Ave Auburn, ME 04210

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)

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F-Tag F0689

Quality of Life and Care Deficiencies
Harm Level: Immediate Jeopardy

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

feet off the floor. The LPN completed a brief assessment and determined transport to the Emergency Department was indicated and called 911. The LPN stated Resident #1 had demonstrated no signs of illness or concerns prior to the fall, but had considerable pain afterwards, however, this was baseline for Resident #1. The resident had demanded to be put back to bed. On [DATE REDACTED] at 2:50 p.m., in an interview with two surveyors, the Administrator confirmed the facility had no policy or procedure regarding bed safety or bed height. On [DATE REDACTED] at 11:45 a.m., in a telephone interview with a surveyor, the Interim Director of Nursing confirmed Resident #1 did not have bed rails. At one time, Resident #1 had a halo assistive device, but it had been removed at the resident's request. Based on the above information, IJ was determined to exist on [DATE REDACTED] at 3:25 p.m. for the facility's failure to provide adequate supervision to a dependent resident left alone in a side-lying position on an air mattress, without a side rail and with the bed left at an unsafe height, approximately 3 and a half feet from the floor, resulted in an avoidable accident. The facility's failure to ensure safety and supervision constituted an immediate jeopardy situation. Please see F-000 Initial Comments related to the IJ removal plan.

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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Clover Health Care

440 Minot Ave Auburn, ME 04210

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)

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F-Tag F0949

Administration Deficiencies
Harm Level: Potential for More Than Minimal Harm

Federal health inspectors cited CLOVER HEALTH CARE in AUBURN, ME for a deficiency under regulatory tag F-F0949 during a complaint investigation conducted on 2025-08-13.

Category: Administration Deficiencies

The facility was found deficient in the following area: Provide behavior health training consistent with the requirements and as determined by a facility assessment.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 3 deficiencies cited during this inspection of CLOVER HEALTH CARE.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-02.

📋 Inspection Summary

CLOVER HEALTH CARE in AUBURN, ME inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in AUBURN, ME, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from CLOVER HEALTH CARE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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