Cloverleaf Terrace

Last survey

April 23, 2026 standard survey, complaint

Surveys

3

Deficiencies cited

17

Enforcement letters

2

Forfeitures imposed

$3,100 2 notices

Complaints substantiated

4 of 5 as stated in the reports

Enforcement

• July 23, 2026: notice of violation, order to comply, special orders, forfeiture, forfeiture $2,600 (reduced to $1,690 if paid within ten days)
• November 5, 2024: notice of violation, order to comply, special orders, forfeiture, forfeiture $500 (reduced to $325 if paid within ten days)

April 23, 2026, standard survey, complaint · statement of deficiency

• Administrator shall supervise daily operation (DHS 83.15(3)(a)) Administrator
  From the report: Based on record review and interview, the administrator did not uphold his/her responsibilities to supervise daily operations including protection of residents' health and safety and ensuring their rights are respected.
• Licensee conduct caregiver background check (DHS 83.17(1)) Hiring and employment
  From the report: Based on record review and interview, the provider did not conduct and document a caregiver background check following the procedures in s.
• Employees screened for communicable disease (DHS 83.17(2)(a)) Hiring and employment
  From the report: Based on record review and interview, the provider did not ensure 3 of 3 employees reviewed (Assistant Administrator B, Caregiver D, and Caregiver E) were screened for tuberculosis and communicable disease by a physician, physician assistant, clinical nurse practitioner or a licensed registered nurse.
• Continuing education (DHS 83.25) Continuing education
  From the report: Based on record review and interview, the provider did not ensure Assistant Administrator B received at least 15 hours of continuing education beginning with the first full calendar year of employment.
• Annual evaluation of evacuation limits (DHS 83.35(5)(b)) Assessment, individual service plan and evaluations
  From the report: Based on record review and interview, the provider did not ensure 2 out of 2 residents reviewed (Resident 1 and Resident 2) had annual evacuation evaluations completed.

January 15, 2025, verification visit · statement of deficiency

• No deficiencies listed in the statement

July 19, 2024, complaint 4 of 5 complaints substantiated · statement of deficiency

• Rights of Residents: Receive medication (DHS 83.32(3)(h)) Rights of residents
  From the report: Based on record review and interview, the provider did not ensure Resident 2 received medications as ordered.
• Leisure time activities (DHS 83.38(1)(c)) Program services
  From the report: Based on observation and interview, the provider did not ensure a daily activity program to meet the interests and capabilities of residents was provided.
• Resident record maintained (DHS 83.42(1)) Resident records
  From the report: Based on record review and interview, the provider did not maintain Resident 1's record to include his/her assessments, documentation to accurately describe his/her condition, and individual service plan (ISP).
• Environment safe, clean, and comfortable (DHS 83.43(1)) Furnishings and equipment
  From the report: Based on observation and interview, the provider did not ensure the residents' living environment was safe, clean, comfortable, and homelike.
• Fire drills (DHS 83.47(2)(d)) Fire safety requirements
  From the report: Based on record review and staff interview the provider did not ensure fire drills were conducted quarterly including at least one drill simulating the conditions during usual sleeping hours between 01/01/2023 and 07/01/2024.
• Other evacuation drills (DHS 83.47(2)(e)) Fire safety requirements
  From the report: Based on record review and staff interview the provider did not ensure evacuation drills, such as tornado, flooding or other emergency or disaster, were conducted at least semi-annually in 2023.
• Privacy (Wis. Stat. 50.09(1)(f))
  From the report: Based on observation and interview, the provider did not ensure Resident 1's privacy and unrestricted communication was protected when an auditory monitor was placed in his/her room and the receiver was stored on a counter in the common area audible to anyone in the facility.

Read the survey history on DQA’s Provider Search →

DQA posts surveys from the last three years. DHS says posting may be delayed and Provider Search is updated weekly. This community is licensed for 15 residents; larger communities are surveyed and reported on more often, so read counts with size in mind. Source: Wisconsin Department of Health Services, Division of Quality Assurance, data as of October 15, 2026. Always visit in person and ask the community about anything listed here.