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

Country Terrace Black River Falls II

642 E 3rd St, Black River Falls, WI 54615 · Jackson County · 25 licensed beds

DQA licence number 0016076 · licensed, regular licence · first licensed March 2016

The licence

Licensed by DQA · Community-based residential facility · For profit · managed by Country Terrace of Wisconsin INC

Licence details, as listed by DQA
Licensed as
Community-based residential facility
Class
Class CNA (non-ambulatory)
Regular licence issued
March 17, 2016
Client groups served
Advanced aged, Irreversible dementia/Alzheimer's, Physically disabled, Terminally ill
Ownership
Limited Liability Company
35
Citations on file
Since October 2023
8
DQA visits
1 routine inspection
5
Building-related
Physical plant · emergency

Position within Wisconsin

35 citations — more than 98% 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 Country Terrace Black River Falls II

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.

  • N393 Initial evaluation of evacuation limitationsMarch 3, 2025
  • N481 Environment safe, clean, and comfortableMarch 3, 2025
  • N525 Fire drillsMarch 3, 2025
  • N481 Environment safe, clean, and comfortableOctober 10, 2024
  • N481 Environment safe, clean, and comfortableMarch 27, 2024

How that compares

Citations on file over 3 years

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

This facility35Wisconsin median1
Citations on file over 3 years, compared
MeasureCitations
This facility35
Median facility in Wisconsin1

Visit history

Citations at each DQA visit
02023-10142024-0302024-0742024-10122025-0342025-1212026-0302026-05
Citations at each DQA visit
VisitTypeCitations
October 31, 2023complaint investigation, verification visit0
March 27, 2024complaint investigation14
July 11, 2024complaint investigation0
October 10, 2024complaint investigation, verification visit4
March 3, 2025survey, complaint investigation, verification visit12
December 1, 2025complaint investigation, verification visit4
March 3, 2026complaint investigation1
May 13, 2026complaint investigation, verification visit0

What the citations cover

Citations by category (TagProof's grouping)
  • Resident care 13
  • Records and administration 7
  • Medication 6
  • Staffing and training 3
  • Other 6
Citations by category
CategoryCitations
Resident care13
Records and administration7
Medication6
Staffing and training3
Physical plant3
Life safety2
Food service1

Every visit on file since October 2023

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

May 13, 2026 — complaint investigation, verification visit, nothing cited

March 3, 2026 — complaint investigation, 1 citation

Citations from the complaint investigation on March 3, 2026
TagWhat DQA checks
N432Medication administration

December 1, 2025 — complaint investigation, verification visit, 4 citations

Citations from the complaint investigation, verification visit on December 1, 2025
TagWhat DQA checks
N169Notification: incident, injury, changes
N410Medication error or adverse reaction
N415Documentation of medication administration
N427Leisure time activities

March 3, 2025 — survey, complaint investigation, verification visit, 12 citations

Citations from the survey, complaint investigation, verification visit on March 3, 2025
TagWhat DQA checks
N214Administrator shall supervise daily operation
N277Continuing education
N310Admission agreement include services, charges
N343Explanation of rights, grievance procedure
N381Pre-admission and ongoing assessments
N386Comprehensive Individualized Service Plan
N392Resident satisfaction evaluation
N393Initial evaluation of evacuation limitations
N415Documentation of medication administration
N427Leisure time activities
N481Environment safe, clean, and comfortable
N525Fire drills

October 10, 2024 — complaint investigation, verification visit, 4 citations

Citations from the complaint investigation, verification visit on October 10, 2024
TagWhat DQA checks
N214Administrator shall supervise daily operation
N352Rights of Residents: Receive medication
N415Documentation of medication administration
N481Environment safe, clean, and comfortable

July 11, 2024 — complaint investigation, nothing cited

March 27, 2024 — complaint investigation, 14 citations

Citations from the complaint investigation on March 27, 2024
TagWhat DQA checks
N158Caregiver: Investigating abuse & neglect
N165Reporting incidents with serious injury
N214Administrator shall supervise daily operation
N229Employee records available upon request
N239Department-approved training courses
N352Rights of Residents: Receive medication
N410Medication error or adverse reaction
N415Documentation of medication administration
N425Personal care
N431Health monitoring
N441Hand washing
N452Food safety
N480Access to resident records
N481Environment safe, clean, and comfortable

October 31, 2023 — complaint investigation, verification visit, nothing cited

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.