Two in five care homes are falling below expected standards amid concerns about safety, a health watchdog has warned.
Andrea Sutcliffe, the Care Quality Commission's (CQC) chief adult social care inspector, warned many residential homes were "struggling" as she revealed 40% either required improvement or were inadequate.
According to the CQC website, 253 of those homes which have been inspected required improvement and 35 were deemed "inadequate", while some 356 were rated "good" and two "outstanding".
Writing for the Telegraph, she said: "There are concerns about safety and leadership, and many nursing homes are struggling.
"There is too much variation - yes nearly 60% are good or outstanding, but a third require improvement and 7% are inadequate."
Ms Sutcliffe has previously warned the sector is under "stress and strain" as a result of funding cuts to adult social care budgets, which the Association of Directors of Adult Social Services (ADASS) estimated in June amounted to £4.6 billion over the past five years.
As the Government finalises plans under its spending review, she said: "In this climate, it is critical that responses from local services to financial pressures do not increase risks to people's health, safety and well being."
Her comments come as the watchdog carries out assessments of England's 26,310 residential and non-residential adult social care services by March 2016 under a new "tougher" rating and review system introduced last October.
Last month Ms Sutcliffe revealed more than 90% of hospices in England had been rated "good" or "outstanding".