Windsor Care Center of Sacramento

Nursing Home · Sacramento, CA

CMS overall rating 2/5 For profit - Limited Liability company

CMS certification number555717

Contact & location

501 Jessie Avenue
Sacramento, CA 95838
Sacramento County
Phone
(916) 922-8855
ZIP code
95838 – all care providers

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Facility details

Certified beds
128
Ownership
For profit - Limited Liability company
Legal name
Windsor Sacramento Estates, LLC
Chain
Windsor (22 facilities, avg 2.4★)
Medicare certified since
December 30, 1997
Participates in
Medicare and Medicaid
Council
Resident council

CMS star ratings

Overall★★★★★ 2/5
State avg 3.2
Health inspections★★★★★ 2/5
State avg 2.8
Staffing★★★★★ 1/5
State avg 3.3
Quality measures★★★★★ 5/5
State avg 4.1
Long-stay quality★★★★★ 5/5
Short-stay qualityNot rated

Staffing

Hours of nursing care per resident per day, from payroll data. More hours generally mean more time for each resident.

Total nurse staffing
—
Registered nurses (RN)
—
Licensed practical nurses
—
Nurse aides
—
Weekend total
—
Nursing staff turnover
—
RN turnover
—

Inspections

Last standard inspection
December 20, 2024
Health deficiencies (last cycle)
15.0 (state 15.7 · U.S. 9.3)
From complaints
0
Citations on record (3 years)
51 health · 16 fire safety · includes actual harm
DateCitationSeverityStatus
2024-12-20 Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
F0725 · Nursing and Physician Services Deficiencies		 F
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Keep residents' personal and medical records private and confidential.
F0583 · Resident Rights Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Provide care and assistance to perform activities of daily living for any resident who is unable.
F0677 · Quality of Life and Care Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Provide activities to meet all resident's needs.
F0679 · Quality of Life and Care Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Provide and implement an infection prevention and control program.
F0880 · Infection Control Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
F0921 · Environmental Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F0550 · Resident Rights Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Reasonably accommodate the needs and preferences of each resident.
F0558 · Resident Rights Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Ensure each resident receives an accurate assessment.
F0641 · Resident Assessment and Care Planning Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F0684 · Quality of Life and Care Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Provide care or services that was trauma informed and/or culturally competent.
F0699 · Quality of Life and Care Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F0755 · Pharmacy Service Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
F0758 · Pharmacy Service Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Ensure 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 locked compartments, separately locked, compartments for controlled drugs.
F0761 · Pharmacy Service Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F0812 · Nutrition and Dietary Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-12-20 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F0600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-12-27
2024-10-03 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F0600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-10-04
2024-08-22 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F0600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-09-06
2024-08-22 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F0656 · Resident Assessment and Care Planning Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-09-06
2024-07-23 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F0600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-08-05
2024-07-11 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F0609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2024-07-12
2024-05-08 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F0600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 G
Actual harm		 Corrected 2024-05-08
2023-12-20 Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
F0806 · Nutrition and Dietary Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-29
2023-11-16 Observe each nurse aide's job performance and give regular training.
F0730 · Nursing and Physician Services Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
F0805 · Nutrition and Dietary Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F0812 · Nutrition and Dietary Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Have a policy regarding use and storage of foods brought to residents by family and other visitors.
F0813 · Nutrition and Dietary Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F0584 · Resident Rights Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Ensure each resident receives an accurate assessment.
F0641 · Resident Assessment and Care Planning Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
F0657 · Resident Assessment and Care Planning Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Provide care and assistance to perform activities of daily living for any resident who is unable.
F0677 · Quality of Life and Care Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Post nurse staffing information every day.
F0732 · Nursing and Physician Services Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F0755 · Pharmacy Service Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Ensure medication error rates are not 5 percent or greater.
F0759 · Pharmacy Service Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Keep all essential equipment working safely.
F0908 · Environmental Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Make sure that a working call system is available in each resident's bathroom and bathing area.
F0919 · Environmental Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-11-16 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
F0921 · Environmental Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-12-25
2023-10-10 Respond appropriately to all alleged violations.
F0610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-10-19
2023-08-01 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F0600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies · complaint inspection		 D
No actual harm, potential for more than minimal harm		 Corrected 2023-08-23
2021-12-09 Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F0684 · Quality of Life and Care Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
F0726 · Nursing and Physician Services Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F0812 · Nutrition and Dietary Deficiencies		 E
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F0550 · Resident Rights Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
F0557 · Resident Rights Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Reasonably accommodate the needs and preferences of each resident.
F0558 · Resident Rights Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Keep residents' personal and medical records private and confidential.
F0583 · Resident Rights Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Ensure each resident receives an accurate assessment.
F0641 · Resident Assessment and Care Planning Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Provide enough food/fluids to maintain a resident's health.
F0692 · Quality of Life and Care Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Ensure 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 locked compartments, separately locked, compartments for controlled drugs.
F0761 · Pharmacy Service Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09
2021-12-09 Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
F0806 · Nutrition and Dietary Deficiencies		 D
No actual harm, potential for more than minimal harm		 Corrected 2022-01-09

Severity letters A–L combine how widespread a problem was (isolated, pattern, widespread) with how serious (from potential for minimal harm to immediate jeopardy). How to read inspection results

Fines & penalties

No federal fines or payment denials in the last three years.

Ownership & management

NameRoleSince
Windsor Haysac Holdings LLC (organization)5%+ Direct Ownership Interest · 100%
Antelope Holdings I, LLC (organization)5%+ Indirect Ownership Interest
Robin, Aaron (individual)5%+ Indirect Ownership Interest
Tress, Avrohom (individual)5%+ Indirect Ownership Interest
Windsor Oxford Holding Company, LLC (organization)5%+ Indirect Ownership Interest
Robin, Aaron (individual)Corporate Officer · NOT APPLICABLE
Shaw, Pamela (individual)Corporate Officer · NOT APPLICABLE
Tress, Avrohom (individual)Corporate Officer · NOT APPLICABLE
Shaw, Pamela (individual)Operational/managerial Control · NOT APPLICABLE

Frequently asked questions

What is the rating of Windsor Care Center of Sacramento?

Windsor Care Center of Sacramento has a 2-star overall rating from the Centers for Medicare & Medicaid Services on a scale of 1 to 5, compared with a 3.2-star average in California.

How many beds does Windsor Care Center of Sacramento have?

It has 128 certified beds.

Has Windsor Care Center of Sacramento been fined?

CMS lists no federal fines or payment denials in the last three years.

Who owns Windsor Care Center of Sacramento?

It is part of Windsor and is classified as for profit - limited liability company. See the ownership table above for all owners and managers reported to CMS.

What is the phone number of Windsor Care Center of Sacramento?

(916) 922-8855. The facility is located at 501 Jessie Avenue, Sacramento, CA 95838.

Other nursing homes in Sacramento

Compare all nursing homes in Sacramento, CA →

Source: CMS Care Compare, August 2026. Information is provided as published by CMS; verify details directly with the facility.