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Care homes' management of medicines has been severely criticised management in a report by the Commission for Social Care Inspection.

The CSCI called for an urgent review of policy after finding that almost half of all homes, caring for a total of 210,000 vulnerable, older and young people, fail to meet the national standards.

There were no improvements in nursing homes since the last critical assessment in 2004, and the little progress made in care homes was "disappointingly slow", the report said.

It called for homes to "get their house in order" after finding that the £48 million assigned to local authorities to train care workers had made no impact.

The areas homes were failing in were "no different" to those found two years ago, with the homes not appearing "to have learnt from past failings", the report found.

It said that primary care trusts should take more "active steps" to ensure homes gave medicine management a higher priority.

The Healthcare Commission will now be monitoring PCTs and chemists to ensure homes were receiving adequate support, but the commission said it was also necessary for the National Patient Safety Agency to extend its current role in assisting NHS organisations and begin supporting nursing and care homes.

Dame Denise Platt, chair of CSCI said: "It is vital that all care homes treat this issue with the utmost seriousness."