Pioneer House
415 P Street · Sacramento, CA · 95814 · 9164424906
50 certified beds For profit - Limited Liability company Chain: Cypress Healthcare Group
Why this verdict
- Carries CMS’s abuse warning icon.
- No federal fines or payment denials in CMS’s 3-year window.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
CMS abuse warning
CMS flags this facility with its abuse icon: cited for abuse that caused harm in the past year, or potential harm in the past two years.
Cited under the freedom-from-abuse rule
Cited 5 times under F600 (freedom from abuse/neglect) below the actual-harm level — worth asking about on a tour.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 2 of 5 Inspections: 2 of 5 Staffing: 4 of 5 Quality measures: 4 of 5
| Total nurse hours / resident-day | 4.15 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.79 | 0.55–0.75 |
| Weekend hours / resident-day | 3.58 | ≈ weekday level |
| Nursing turnover / year | 44% | median 45% |
| Fines (3-yr window) | none |
Inspection citations (59 in the current record)
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Potential for harm · D February 10, 2026 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected February 23, 2026 · Quality of Life and Care
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Potential for harm · D December 9, 2025 · found via complaint
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Corrected January 12, 2026 · Resident Rights
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Potential for harm · E December 4, 2025
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected December 12, 2025 · Resident Assessment and Care Planning
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Potential for harm · E December 4, 2025
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected December 12, 2025 · Quality of Life and Care
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Potential for harm · E December 4, 2025
Provide enough food/fluids to maintain a resident's health.
Corrected December 12, 2025 · Quality of Life and Care
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Potential for harm · D December 4, 2025
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected December 12, 2025 · Pharmacy Service
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Potential for harm · E December 4, 2025
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.
Corrected December 12, 2025 · Pharmacy Service
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Potential for harm · E December 4, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected December 12, 2025 · Nutrition and Dietary
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Potential for harm · E December 4, 2025
Provide and implement an infection prevention and control program.
Corrected December 12, 2025 · Infection Control
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Potential for harm · E December 4, 2025
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected December 12, 2025 · Environmental
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Actual harm · G November 24, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected November 25, 2025 · Quality of Life and Care
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Potential for harm · D September 5, 2025 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected September 23, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D February 18, 2025 · found via complaint
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
Corrected February 25, 2025 · Nutrition and Dietary
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Potential for harm · D January 24, 2025 · found via complaint
Prepare residents for a safe transfer or discharge from the nursing home.
Corrected February 26, 2025 · Resident Rights
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Potential for harm · D December 26, 2024 · found via complaint
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Corrected January 8, 2025 · Resident Rights
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Potential for harm · E December 19, 2024 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected January 12, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D November 29, 2024 · found via complaint
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected December 5, 2024 · Resident Assessment and Care Planning
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Potential for harm · D November 29, 2024 · found via complaint
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected December 5, 2024 · Quality of Life and Care
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Potential for harm · D November 15, 2024
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Corrected December 15, 2024 · Resident Rights
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Potential for harm · D November 15, 2024
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected December 15, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D November 15, 2024
Honor each resident's preferences, choices, values and beliefs.
Corrected December 15, 2024 · Quality of Life and Care
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Potential for harm · E November 15, 2024
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.
Corrected December 15, 2024 · Pharmacy Service
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Potential for harm · E November 15, 2024
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected December 15, 2024 · Nutrition and Dietary
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Potential for harm · E November 15, 2024
Provide and implement an infection prevention and control program.
Corrected December 15, 2024 · Infection Control
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Potential for harm · E July 18, 2024 · found via complaint
Put firmly secured handrails on each side of hallways.
Corrected July 26, 2024 · Environmental
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 555542 · certified since April 1, 1993. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.