State assisted-living licensing record · Wisconsin DQA · record as pulled October 1, 2026· Not the federal nursing home survey
Black Hawk Senior Residence
1 Milwaukee Ave West, Fort Atkinson, WI 53538 · Jefferson County · 38 licensed beds
DQA licence number 0014288 · licensed, regular licence · first licensed October 2012
The licence
Licensed by DQA · Community-based residential facility · For profit · managed by Black Hawk Residential Operations LLC
Licence details, as listed by DQA
- Licensed as
- Community-based residential facility
- Class
- Class CNA (non-ambulatory)
- Probationary licence issued
- October 3, 2012
- Regular licence issued
- October 1, 2013
- Client groups served
- Advanced aged, Irreversible dementia/Alzheimer's, Physically disabled, Traumatic brain injury
- Ownership
- Limited Liability Company
Position within Wisconsin
5 citations — more than 73% 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.
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Building-related citations
The citation about the building itself — physical plant and emergency management. Usually the maintenance side’s to fix.
- N393 Initial evaluation of evacuation limitationsMay 14, 2025
How that compares
Compared with the median licensed assisted living facility in Wisconsin. Within-state only.
| Measure | Citations |
|---|---|
| This facility | 5 |
| Median facility in Wisconsin | 1 |
Visit history
| Visit | Type | Citations |
|---|---|---|
| May 14, 2025 | complaint investigation, verification visit | 5 |
| September 29, 2025 | complaint investigation, verification visit | 0 |
What the citations cover
- Resident care 2
- Records and administration 1
- Life safety 1
- Staffing and training 1
| Category | Citations |
|---|---|
| Resident care | 2 |
| Records and administration | 1 |
| Life safety | 1 |
| Staffing and training | 1 |
Every visit on file since October 2023
As published by DQA, newest first, including visits that cited nothing. The wording is DQA’s own.
September 29, 2025 — complaint investigation, verification visit, nothing cited
May 14, 2025 — complaint investigation, verification visit, 5 citations
| Tag | What DQA checks |
|---|---|
| N196 | Licensee ensures facility complies with laws |
| N243 | All employee training |
| N289 | Admissions compatible with program statement |
| N302 | Resident health screening and documentation |
| N393 | Initial evaluation of evacuation limitations |
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.