Thousands of vulnerable residents will be at risk if care homes are not fully inspected for 10 years, campaigners warn. The Care Quality Commission - labelled "unfit for purpose" - has been ordered to restore public confidence in how it assesses providers, which are currently rated either outstanding, good, requires improvement or inadequate.

But "significant concerns" remain over proposals for routine inspections to be carried out sporadically as part of an overhaul of how the care quango carries out its duties. The CQC is deliberating on changes to its inspections, but Care Rights UK worries the regulator is unable to comprehensively look at all areas at each visit, which will leave "significant gaps in oversight that could allow poor care to go unregulated".

The charity said: "We have significant concerns about the proposal in the consultation that routine inspections generally occur every 3-5 years.

"The consultation also suggests they would not expect to look comprehensively at every area of every service or cover every part of the assessment framework every time they inspect a service. This means that some parts of a service may not be assessed for ten years at worst."

Inspections are critical for understanding what happens in care settings and addressing poor care.

Campaigners have warned the CQC that it will not get a full picture by relying on whistleblowing or complaints being raised, with research finding 56% of those who witnessed poor care not reporting it.

A government-ordered review into the CQC - which was labelled "not fit for purpose" by Health Secretary Wes Streeting last year - found a catalogue of failings, including an inability to identify poor performance, which undermined the health and social care sector's capacity and capability to improve care.

Dr Penny Dash's damning probe into the shambolic state of care regulation found the oldest rating for a social care organisation was more than eight years old.

There are currently 14,714 care homes under the auspices of the CQC.

Figures obtained by the Express show that of the 13,708 currently rated, 138 are inadequate, 2,265 are requiring improvement, 10,672 are good, and 593 are outstanding.

Some 39 are not rated, while in one case, there is insufficient evidence to rate.

It means one in five is still failing.

I'm a Celebrity... Get Me Out of Here! star and care campaigner Ruthie Henshall told the Express quality is now so dire she would rather be shot than dumped in a home.

Actress Ruthie, 58, was banned from hugging or holding her former teacher mum Gloria who battled Parkinson's and dementia before her death aged 87 in 2021 at the height of the Covid pandemic.

She said: "I have already asked my sister, 'please take me out'. If I have dementia, and I have any capacity, there is no way I am going into a care home. What I witnessed and what went through with mum was so horrific."

The CQC ranked Spring Lodge Care Home in Ipswich, Suffolk, where Gloria was a resident, as "requires improvement" after an inspection in August 2021 and gave it the same score after an unannounced inspection in October 2022. There has been no subsequent visit in more than three years.

The CQC said it carried out 2,009 residential social care inspections between January 1 and December 9. It said the average time between visits was 758 days or 2.1 years.

Earlier this year Sir Julian Hartley, former boss of the watchdog, said the public could no longer trust safety ratings when choosing a care home because the CQC had "lost its way" with too few inspections and reports that were years out of date.

In some cases, it meant families had no idea of the standard of care loved ones had been receiving.

Sir Julian was appointed to a £285,000-a-year role in December last year to clear up a catalogue of disasters. He quit in October - the same month the CQC launched a consultation on proposals for reform that could include making all care home inspections unannounced by default.

Before he left he said: "If you're thinking about where to put your mum in a care home you want to have reliable information that's up to date. Effectively, the CQC is not delivering on its operational performance. It's not delivering for people that use services and patients.

"The Express has been an insistent voice in calling for improvement in social care, which is why I'm committing to readers that we will do better as a regulator, so we can help services provide better care.

"This won't happen overnight. But while there is too much poor care, there are also many services delivering kind, compassionate, outstanding care - and we want to help make that the reality for everyone."

Failure to provide reliable and up-to-date information has seen some families forking out £1,500 a week for basic levels of care for loved ones turn to a new Tripadvisor-style ratings system.

OpenScore claims to be the UK's first live, continually updated view of care home quality, ranking facilities daily on a live, interactive map.

Founder Debbie Harris said: "Care homes can wait years for a new CQC inspection. These old ratings hide the truth and mask real problems, while also holding back homes that have made genuine progress. For instance, the average time between CQC inspections in the Royal Borough of Windsor and Maidenhead is 5.25 years - the highest of anywhere in the country and in stark contrast to OpenScore's data, which updates daily. That gap hurts families - and it hurts homes working hard to improve."

Layla Moran, Chair of the Health and Social Care Committee, said: "Our country's social care system continues to languish without any reform in the near future, so it is even more essential the public at least has a reliable regulator that holds services to account. No wonder people are turning to other sources of information for advice."

The CQC is considering proposals to improve the assessment of health and care services, make judgements, and award ratings as part of a strategy called "better regulation, better care".

Chris Badger, CQC's Chief Inspector of Adult Social Care, said: "We know we need to increase our rate of assessments to make sure that we update the ratings of providers and give the public confidence in quality of care. "Since accepting the recommendations in Penny Dash's review last year, we have worked hard to develop how we fulfil our vital role of helping people receive a high level of care as well as supporting providers to improve. This included making a clear commitment to increasing the number of assessments we carry out.

"It is also important to recognise that while we might not inspect a care home for a period of time, we do also continuously monitor services so that we can respond to issues that arise. This allows us to focus our resources in the places where there is highest risk. When people share their concerns about poor care with us, they can have confidence that we will act to hold providers to account to ensure people are kept safe and treated with the dignity and respect they deserve."

The Department of Health and Social Care said: "It is essential that patients and their families are able to make informed decisions about their care. This government inherited a CQC that was not fit for purpose. Since then, we have taken decisive action to improve the performance of the regulator, implementing all recommendations from Dr Penny Dash's review of its operational effectiveness.

"We are supporting the CQC and holding it to account to ensure that improvements are made rapidly - the CQC is now broadly on track to meet assessment targets for this year."