The fire broke out at about 11:20 p.m. at the Canevalley Circle home, which was home to six patients.
State law requires sprinklers in care homes that house seven patients or more. Fire officials have been fighting for the past three years for state legislation to require sprinklers in homes with fewer patients, but those efforts have failed.
The two women who died were trapped by flames at the back of the home, said Capt. Jeff Lynch, spokesman for the Sacramento Metropolitan Fire District.
Lynch said rescuers did all they could to reach the two women.
"Unfortunately, we couldn't reach them in time," he said.
Five others were injured, including a woman in her 90s who suffered from smoke inhalation. Neighbors were credited with helping to save some of the patients.
Many family members of patients quickly came to the scene of the fire.
"When you hear something like that on the news, and the uncertainly of it, it's horrible," said Janice Johanson, whose mother was evacuated to safety.
Lynch said when fire crews arrived, flames and smoke were seen pouring out of the home. Officials estimated that the fire caused $500,000 in damage.
The intense fire also spread to a house next door, but firefighters worked quickly to limit the damage.
The cause of the blaze is still under investigation.
"With the two fatalities, in particular, we don't want to leave anything unturned," Lynch said. "So we're doing a very thorough investigation and we're hoping to have some answers soon."
Officials said 42 firefighters battled the blaze. None were injured.
The facility had smoke detectors, pull boxes with alarms and exit doors in every room.
The facility passed a fire inspection in 2003, but has not been inspected since that time. The state does not require annual fire inspections.
One advocate for the elderly said there is little oversight or accountability when it comes to such homes in California.
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