More than a third of England’s 4,000 nursing homes are failing on safety, according to inspectors.
Drug errors, lack of staff and falls were highlighted by the Care Quality Commission in its review.
Safety was also a major issue in other services for the elderly and disabled, including care homes and home help.
The CQC said the failings were “completely unacceptable”, as it unveiled the full findings of its new inspection regime for the care sector.
The new “tougher” system was launched in 2014, amid concerns problems were going undetected.
The CQC has now completed inspections for all 24,000 services in the sector, which provide care to one million vulnerable people.
More than 200,000 of them live in nursing homes, which had the most serious problems.
Some 37% of homes failed on safety, with inspectors noting they had a particular problems recruiting and retaining nurses.
Just below a quarter of care homes and home helps were rated not safe enough, while in community support, including sheltered housing, 17% fell short.
The CQC highlighted poor care inspectors had found, including:
the death of a 62-year-old man who had broken his neck in a fall from a shower chair at a West Yorkshire care home. The company in charge of the site, St Anne’s Community Services, was prosecuted and fined £190,000
a number of cases where residents had been put back to bed in the morning because there had not been enough staff to provide them with support
a 79-year-old woman left with serious burns after falling against an uncovered radiator at Manor Residential Home in London
cases where incontinence pads had not been changed regularly and had even reused in some instances
a resident of a home who had died after errors with his anti-blood clotting drugs
a home that had managed its rotas so badly that care staff had had to help out in the kitchen at lunchtime when residents had needed help
a home care service in Lincolnshire, Aamina, that had missed calls or carried out rushed visits, with examples of 30-minute calls being done in five
Overall, inspectors have successfully prosecuted five care providers and another 1,000 have had enforcement action taken against them, from being closed down to handed warning notices.
All the services deemed to be failing would continue to be monitored and re-inspected, the CQC said.
How to pick a good care home
Age UK advises families to check:
the latest CQC report on the home
whether the staff are friendly and welcoming
if senior staff are on duty at all times and whether they know residents and families personally
whether residents can choose their daily routines
the ratio of staff to residents and the turnover of staff
Caroline Abrahams, of Age UK, said the findings were “alarming” and vulnerable people were “effectively playing Russian roulette when they need care”.
She added: “Taken as a whole, this report is a graphic demonstration of why older people desperately need the government to follow through on its commitment to consult on proposals for strengthening social care later this year.”
Margaret Willcox, president of the Association of Directors of Adult Social Services, said councils and providers would be “re-doubling our mutual efforts to ensure older and disabled people and their families get the reliable, personal care they need and deserve”.