Nursing HomeInspections

Windsor Care Center of Sacramento

Nursing home in Sacramento, CA

Medicare & Medicaid certified2★ overall (CMS)

Call (916) 922-8855Send a messageMap ↗

Public-record details

Address
501 Jessie Avenue, Sacramento, CA 95838
Phone
(916) 922-8855
Listed under
For-profit, No fines in 3 years
Medicare CCN
555717
Overall star rating
2 of 5 ★★☆☆☆
Health inspection rating
2 of 5
Staffing rating
1 of 5
Quality measures rating
5 of 5
Certified beds
128
Ownership
For-profit, limited Liability company
Legal business name
Windsor Sacramento Estates, LLC
Chain
Windsor (22 facilities)
Certified for
Medicare and Medicaid
First approved by Medicare/Medicaid
Dec 30, 1997
Changed ownership in last 12 months
No
Continuing care retirement community
No
Located inside a hospital
No
Resident or family council
Resident council
Sprinklers in all required areas
Yes

CMS certification number 555717. Source: CMS Nursing Home Provider Information, Health Deficiencies and Penalties (record). Data as of 2026-09-30.

Inspection record

Most recent standard health inspection: Dec 20, 2024. CMS lists 51 health citations for this facility across its last three standard inspection cycles and complaint inspections (Dec 9, 2021 to Dec 20, 2024): 10 from complaint inspections, 1 at the “actual harm” level or higher.

InspectionCitationSeverity
Dec 20, 2024Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights
D
Potential for more than minimal harm, isolated
Dec 20, 2024Reasonably accommodate the needs and preferences of each resident.
Resident Rights
D
Potential for more than minimal harm, isolated
Dec 20, 2024Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning
D
Potential for more than minimal harm, isolated
Dec 20, 2024Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care
D
Potential for more than minimal harm, isolated
Dec 20, 2024Provide care or services that was trauma informed and/or culturally competent.
Quality of Life and Care
D
Potential for more than minimal harm, isolated
Dec 20, 2024Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service
D
Potential for more than minimal harm, isolated
Dec 20, 2024Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and…
Pharmacy Service
D
Potential for more than minimal harm, isolated
Dec 20, 2024Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in…
Pharmacy Service
D
Potential for more than minimal harm, isolated
Dec 20, 2024Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary
D
Potential for more than minimal harm, isolated
Dec 20, 2024Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Freedom from Abuse, Neglect, and Exploitation · complaint inspection
D
Potential for more than minimal harm, isolated
Dec 20, 2024Keep residents' personal and medical records private and confidential.
Resident Rights
E
Potential for more than minimal harm, pattern
Dec 20, 2024Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care
E
Potential for more than minimal harm, pattern

Showing the 12 most recent of 51. Full inspection reports are on Medicare Care Compare.

Severity letters follow CMS's scope-and-severity grid: A–C potential for minimal harm, D–F potential for more than minimal harm, G–I actual harm, J–L immediate jeopardy. Most citations are corrected; a citation is what inspectors found on that date. Source: CMS Health Deficiencies file, processed Aug 1, 2026.

Fines and payment denials

CMS records no fines or payment denials for this facility in the last three years.

Source: CMS Penalties file, processed Aug 1, 2026. Amounts are as CMS reports them and may reflect later reductions or appeals.

A citation is what inspectors found on one date; most are corrected within weeks. Look for patterns — the same problem cited in several inspections — and for anything at the G–L level (actual harm or immediate jeopardy). The full inspection narrative (Form CMS-2567) is linked from Medicare Care Compare, and your state long-term care ombudsman can tell you about complaints.

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