Themed spot checks will be part of a new inspection regime aimed at raising standards for the 500,000 adults living in 20,000 care homes.

The Times disclosed in June that the homes would be given hotel-style rankings so that residents and their relatives know what standard of service to expect.

Care homes must meet minimum standards, but there is no way of telling if a home has passed with flying colours or just met requirements. It is said that this offers little incentive for homes to improve above the basic level. The ratings, from four stars for excellent to one star for poor, will be awarded according to the calibre of care given as well as the quality and condition of equipment and accommodation.

The consultation document published today by the Commission for Social Care Inspection reveals, however, that the new regime will be far more exacting than was at first envisaged.

As well as key inspections of individual homes to investigate their facilities and staff, there will be themed inspections into specific aspects of social care: food and medication are specifically mentioned in the consultation document.

Many homes have been criticised for the quality of the food that they serve and others have been criticised for keeping residents on unnecessarily high levels of sedatives. “No matter how good a service is, we might turn up to inspect it on any day at any time,” the document says. “Poor” one-star homes will have at least two inspections a year and maybe more. Two-star “adequate” homes will have at least one visit a year. “Good” three-star homes will have one every two years and “excellent” four-star ones will have one every three years.

A quality rating will be suspended if there is any evidence of neglect or signs that the health and safety of residents has been compromised.

The proposals also require care homes to ensure that residents are able to keep up with their hobbies and activities.

All homes will be asked to provide access to “leisure, social activities and lifelong learning and to universal, public and commercial services”. That means that those who have enjoyed attending the theatre or concerts can insist that arrangements are made for them to continue going if they are able.

They also set out clear guidelines on “end-of-life” management, making clear that residents have a right to refuse invasive treatment.

The adult care-home sector in Britain is worth about £12 billion a year and employs one million people. Homes charge between £21,000 and £42,000 a year for a place.

Dame Denise Platt, chairwoman of the commission, said that she hoped that the new inspection system would make clear to residents and relatives whether they were getting good value for money and end the perception that expensive homes guarantee good-quality care. “Since [the commission] was created we have highlighted the persistent discrepancy between the cost and the quality of social care,” she said. “Resolving this discrepancy is one of our foremost ambitions.”

Expensive homes with glossy brochures and high-tech equipment can often lack the personal care that residents need, she believes, and small establishments offer better, more individual care.

Experts say, however, that they fear that the new star ratings will result in a two-tier system with people who are paying for themselves prepared to go only to four and three-star homes, but those paid for by their local authorities ending up at the one and two-star establishments.

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