Pine Tree CBRF

Last survey

June 12, 2026 verification visit

Surveys

3

Deficiencies cited

15

Enforcement letters

2

Forfeitures imposed

$2,150 2 notices

Complaints substantiated

1 of 1 as stated in the reports

Enforcement

• February 13, 2026: notice of violation, order to comply, forfeiture, forfeiture $1,150 (reduced to $747.50 if paid within ten days)
• October 16, 2025: notice of violation, order to comply, forfeiture, forfeiture $1,000 (reduced to $650 if paid within ten days)

June 12, 2026, verification visit · statement of deficiency

• No deficiencies listed in the statement

December 15, 2025, verification visit · statement of deficiency

• Orientation (DHS 83.19) Orientation
  From the report: Based on record review and interview, the provider did not ensure Caregiver E received orientation training in all required topics prior to performing job duties.
• Resident health screening and documentation (DHS 83.28(4)(a)) Admission procedures
  From the report: Based on record review and interview, the provider did not ensure Resident 1 was screened for clinically apparent communicable disease, including tuberculosis (TB), by a physician, physician assistant, clinical nurse practitioner or a licensed registered nurse within 90 days before or 7 days after admission.
• Explanation of rights, grievance procedure (DHS 83.32(2)(a)) Rights of residents
  From the report: Based on record review and interview, the provider did not obtain a signed statement acknowledging the provider explained resident rights, the grievance procedure and house rules to 2 of 2 residents reviewed (Resident 1 and Resident 2).
• 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 a living environment that was safe, clean, comfortable and homelike.

August 19, 2025, standard survey, complaint 1 of 1 complaints substantiated · statement of deficiency

• Orientation (DHS 83.19) Orientation
  From the report: Based on record review and interview, the provider did not ensure Caregiver B and Caregiver C received orientation training in all required topics prior to performing job duties.
• All employee training (DHS 83.21(1)-(3)) All employee training
  From the report: Based on record review and interview, the provider did not ensure Caregiver B obtained all training within 90 days after starting employment.
• Resident health screening and documentation (DHS 83.28(4)(a)) Admission procedures
  From the report: Based on record review and interview, the provider did not ensure 1 of 2 residents reviewed (Resident 1) was screened for clinically apparent communicable disease, including tuberculosis (TB), by a physician, physician assistant, clinical nurse practitioner or a licensed registered nurse within 90 days before or 7 days after admission.
• Admission agreement include services, charges (DHS 83.29(2)) Admission agreement
  From the report: Based on record review and interview, the provider did not ensure 1 of 1 residents reviewed had a signed and dated admission agreement.
• Explanation of rights, grievance procedure (DHS 83.32(2)(a)) Rights of residents
  From the report: Based on record review and interview, the provider did not obtain a signed statement acknowledging the provider explained resident rights, the grievance procedure and house rules to 2 of 2 residents reviewed (Resident 1 and Resident 2).

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 8 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.