State assisted-living licensing record · Wisconsin DQA · record as pulled October 1, 2026· Not the federal nursing home survey

Cloverleaf Terrace LLC

401 Center St, Birnamwood, WI 54414 · Shawano County · 15 licensed beds

DQA licence number 0015404 · licensed, regular licence · first licensed December 2014

The licence

Licensed by DQA · Community-based residential facility · For profit · managed by Cloverleaf Terrace LLC

Licence details, as listed by DQA
Licensed as
Community-based residential facility
Class
Class CNA (non-ambulatory)
Probationary licence issued
December 23, 2014
Regular licence issued
January 1, 2016
Client groups served
Advanced aged, Irreversible dementia/Alzheimer's, Physically disabled, Terminally ill, Developmentally disabled, Traumatic brain injury
Ownership
Limited Liability Company
17
Citations on file
Since October 2023
3
DQA visits
1 routine inspection
7
Building-related
Physical plant · emergency

Position within Wisconsin

17 citations — more than 93% of the 1,894 licensed assisted living facilities in Wisconsin. Compared only within Wisconsin: a citation from DQA means what it means in Wisconsin, and there is no national assisted living record to compare to. Counted over 3 years, which holds two or three routine inspections. How this is calculated

Not in this record

Fire and building code inspection, severity, the surveyor's narrative, and enforcement. The fire and building code inspection of a Wisconsin facility is the local fire department's and the state building authority's, and is not part of DQA's record; what DQA itself cites about the building — its physical environment, building maintenance, building support systems and fire safety rules — is here. DQA assigns no severity on these statements, and the plan of correction is the facility's own text and is not republished. Forfeitures and orders are issued in separate enforcement letters and are not republished, and an owner that is a sole proprietor is not named. Adult family homes, three or four beds, are also assisted living in Wisconsin and are not included.

Get an email about Cloverleaf Terrace LLC

One email when it happens, from the DQA record as it is pulled each month. No account; stop it any time with one click.

Which alerts

This is the state licensing record, not the federal nursing home survey. Your address is used for these alerts and nothing else.

Building-related citations

The citations about the building itself — physical plant and emergency management. Usually the maintenance side’s to fix.

  • N394 Annual evaluation of evacuation limitsApril 23, 2026
  • N525 Fire drillsApril 23, 2026
  • N526 Other evacuation drillsApril 23, 2026
  • N538 Fire detection systems inspected annuallyApril 23, 2026
  • N481 Environment safe, clean, and comfortableJuly 19, 2024
  • N525 Fire drillsJuly 19, 2024
  • N526 Other evacuation drillsJuly 19, 2024

How that compares

Citations on file over 3 years

Compared with the median licensed assisted living facility in Wisconsin. Within-state only.

This facility17Wisconsin median1
Citations on file over 3 years, compared
MeasureCitations
This facility17
Median facility in Wisconsin1

Visit history

Citations at each DQA visit
72024-0702025-01102026-04
Citations at each DQA visit
VisitTypeCitations
July 19, 2024complaint investigation7
January 15, 2025verification visit0
April 23, 2026survey, complaint investigation10

What the citations cover

Citations by category (TagProof's grouping)
  • Life safety 6
  • Resident care 4
  • Staffing and training 3
  • Records and administration 2
  • Other 2
Citations by category
CategoryCitations
Life safety6
Resident care4
Staffing and training3
Records and administration2
Medication1
Physical plant1

Every visit on file since October 2023

As published by DQA, newest first, including visits that cited nothing. The wording is DQA’s own.

April 23, 2026 — survey, complaint investigation, 10 citations

Citations from the survey, complaint investigation on April 23, 2026
TagWhat DQA checks
N214Administrator shall supervise daily operation
N219Licensee conduct caregiver background check
N220Employees screened for communicable disease
N277Continuing education
N394Annual evaluation of evacuation limits
N416Other administration given or delegated by RN
N426Supervision
N525Fire drills
N526Other evacuation drills
N538Fire detection systems inspected annually

January 15, 2025 — verification visit, nothing cited

July 19, 2024 — complaint investigation, 7 citations

Citations from the complaint investigation on July 19, 2024
TagWhat DQA checks
N352Rights of Residents: Receive medication
N427Leisure time activities
N454Resident record maintained
N481Environment safe, clean, and comfortable
N525Fire drills
N526Other evacuation drills
Y3235Privacy

Reflects the DQA record as pulled October 1, 2026. A recent visit may not appear yet. This is the Wisconsin state licensing record; it is not the federal nursing home survey and the two are never combined.