It comes after a report by the Care Quality Commission revealed vulnerable people were at risk of receiving "poor or unsafe care" as pressures on care services take their toll.

Care home bosses today stressed that residents were safe but said they were under pressure to provide a paper trail that showed they met the demands.

They also said that the ageing population meant that residents were coming to them much older and more frail than they were in the past, which increases the risk of not meeting rigorous standards.

An analysis of Care Quality Commission inspections carried out over the past two years showed that out of 279 homes, 120 had not met all five of the main standards.

The homes, which all cater for people either 65 years old or over or for people with dementia, were told to make improvements in at least one area.

The CQC ranks homes on:

• Standards of treating people with respect and involving them in their care

• Standards of providing care, treatment & support which meets people’s need

• Standards of caring for people safely & protecting them from harm

• Standards of staffing

• Standards of management

In some cases enforcement action has had to be taken.

The CQC website shows that out of 71 homes caring for elderly people in Cannock Chase, Lichfield, Stafford and South Staffordshire, 21, were told to improve in at least one area. In Dudley it was 33 out of 56 homes while in Walsall it was 27 out of 46.

In Wolverhampton 30 out of 65 care homes did not meet all five key standards.

One home that now passes all five key areas after being told to make improvements is Woodfields Residential Home in Tettenhall. The home has 15 residents and was inspected in April.

CQC inspectors found its care plans "lacked sufficient information about the care needs of residents and how staff were to manage these."

Manager Andy Upmalis said: "The problem was providing the documentary evidence. People are well-cared for and anyone can see that when they meet our residents.

"We have a resident who has been here for 20 years so the fact that people are properly cared for is not in question.

"There is a lot more expected of care homes these days. The average age of a resident 10 years ago was 82. Now our youngest resident is 82 and most people come to us in their 90s."

Damning inspections can lead to care home closures. Chase Nursing Home in Brownhills closed in October after being issued with a formal warning by the CQC. The report said improvements were needed in relation to care and welfare, consent to care and treatment and the management of medicines.

Councillor Steve Evans, who oversees adult social care for Wolverhampton City Council, said: "Personally I believe the CQC is being more rigorous in its checks. That can only mean an improvement in standards. We expect care homes to treat people as individuals.

"There is more expected of care homes than before because people are living much longer and the staff have to be trained to cope with a very different set of circumstances."

John Mellor, president of the Wolverhampton Pensioners' Convention and chairman of the city's Link health watchdog, said: "This is becoming an increasing concern. Years ago, when I was a councillor, I would go and visit care homes in my ward unannounced four times a year. The CQC goes about every two years unless it finds a problem, which is totally inadequate.

"It does not take that long for a well-run care home to descend into real problems."

Nationally, evidence found from 13,000 CQC inspections, found that one in 10 NHS hospitals did not meet basic respect and dignity standards.

And at 15 per cent of 2,500 nursing homes there was a lack of respectful care.

Inspectors noted that 20 per cent of 1,362 nursing homes and residential care homes and 15 per cent of 258 NHS hospitals failed to ensure that the people in their care were given the food and drink they need or helped them to eat or drink. The CQC also raised concerns about staff numbers.

It found that 16 per cent of 250 NHS hospitals did not have adequate staffing levels and a quarter of nursing homes failed to meet the CQC staff standards. Increased pressure on care providers is leading to slip-ups in basic care practices such as record-keeping and medicine management, the CQC said. More than one-in-five NHS hospitals failed to meet standards in medicine management and 22 per cent had poor record-keeping, inspectors found.

David Behan, chief executive of the CQC, said: "Our report highlights concerns we have that pressures on some services are leading to problems in the quality of care, keeping people safe, treating people with dignity and respect, and involving people in decisions about their own care.

"These pressures can not be used as an excuse to deliver poor care. Health and care services need to rise to the challenge of responding to the increasingly complex conditions suffered by our ageing population. That means delivering care that is based on the person's needs, not care that suits the way organisations work. It also means that different services need to work well together in an integrated way."

Paperwork soars to meet demands

Red tape and paperwork is soaring as care homes work to meet the demands placed on them by health watchdogs.

For Woodfields Residential Home in Wolverhampton, every last detail of each resident's day is documented, down to the times they are offered a drink and which cup they drink it out of.

The home in Old Hill has been there for around 40 years. Manager Andy Upmalis has been in charge for just over a year but it has been in his family since 1993.

The 38-year-old called in consultants to make sure his paperwork was up to scratch after the Care Quality Commission found it was "not compliant" in five areas in April 2012. A re-inspection in August found that it passes every area. Mr Upmalis said: "You have to have details of everything in the plan. If when you are observed the resident is using the wrong cup, that's a mark against you.

"Care plans 20 years ago would be a single sheet of paper. Now they are a folder.

"We have to keep a complete audit trail."

Deputy manager Gail Bond, who has worked there for 12 years, added: "How homes have to handle dementia has really changed in the past couple of years.

"Nobody is the same and that's always been the case. But you can have one resident who becomes aggressive at certain parts of the day or who needs somewhere quiet to go."

The home has 16 residents, one of them, 87-year-old Beryl Cutler, has been there for more than 20 years.

Mother-of-one Mrs Cutler went into Woodfields when her husband James passed away. She had previously lived in Guns Lane in West Bromwich and her daughter Sue Smith lives in Penn.

"I'm certainly not doing badly", Mrs Cutler said. "I have a very comfortable life."

Daniel Wainwright