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

Pine Tree Cbrf

324 Robin Ln, Luxemburg, WI 54217 · Kewaunee County · 8 licensed beds

DQA licence number 0012647 · licensed, regular licence · first licensed December 2008

The licence

Licensed by DQA · Community-based residential facility · For profit · managed by Infinity Care INC

Licence details, as listed by DQA
Licensed as
Community-based residential facility
Class
Class CNA (non-ambulatory)
Probationary licence issued
December 1, 2008
Regular licence issued
December 1, 2009
Client groups served
Physically disabled, Developmentally disabled
Ownership
Corporation - Business
16
Citations on file
Since October 2023
3
DQA visits
1 routine inspection
4
Building-related
Physical plant · emergency

Position within Wisconsin

16 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 Pine Tree Cbrf

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.

  • N481 Environment safe, clean, and comfortableDecember 15, 2025
  • N639 One-hand, one-motion door operationDecember 15, 2025
  • N481 Environment safe, clean, and comfortableAugust 19, 2025
  • N639 One-hand, one-motion door operationAugust 19, 2025

How that compares

Citations on file over 3 years

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

This facility16Wisconsin median1
Citations on file over 3 years, compared
MeasureCitations
This facility16
Median facility in Wisconsin1

Visit history

Citations at each DQA visit
112025-0852025-1202026-06
Citations at each DQA visit
VisitTypeCitations
August 19, 2025survey, complaint investigation11
December 15, 2025verification visit5
June 12, 2026verification visit0

What the citations cover

Citations by category (TagProof's grouping)
  • Resident care 6
  • Staffing and training 3
  • Medication 3
  • Life safety 2
  • Other 2
Citations by category
CategoryCitations
Resident care6
Staffing and training3
Medication3
Life safety2
Physical plant2

Every visit on file since October 2023

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

June 12, 2026 — verification visit, nothing cited

December 15, 2025 — verification visit, 5 citations

Citations from the verification visit on December 15, 2025
TagWhat DQA checks
N230Orientation
N302Resident health screening and documentation
N343Explanation of rights, grievance procedure
N481Environment safe, clean, and comfortable
N639One-hand, one-motion door operation

August 19, 2025 — survey, complaint investigation, 11 citations

Citations from the survey, complaint investigation on August 19, 2025
TagWhat DQA checks
N230Orientation
N243All employee training
N302Resident health screening and documentation
N310Admission agreement include services, charges
N343Explanation of rights, grievance procedure
N392Resident satisfaction evaluation
N404Medication regimen, administration review
N407Scheduled psychotropic medications
N416Other administration given or delegated by RN
N481Environment safe, clean, and comfortable
N639One-hand, one-motion door operation

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.