Neglect contributed to the deaths of five elderly residents at the Orchid View Care Home in West Sussex, a coroner has ruled.
Nineteen elderly residents died after being placed in the care home which was closed down two years ago.
Penelope Schofield, the West Sussex coroner, said there was "institutionalised abuse" at Orchid View care home in Copthorne.
Those involved in the neglect of pensioners at the now defunct home should be "ashamed", she said as it was announced a serious case review has been set up.
A five-week inquest heard how some residents were given wrong doses of medication, left soiled and unattended due to staff shortages and there was a lack of management.
Call bells were also often not answered for long periods or could not be reached by elderly people living at the home, which was deemed "an accident waiting to happen".
"There was institutionalised abuse throughout the home and it started, in my view, at a very early stage, and nobody did anything about it," Ms Schofield said.
"This, to me, was from the top down. It was completely mismanaged and understaffed and failed to provide a safe environment for residents."
Ms Schofield said it was "disgraceful" that the home was allowed to be run in the way it was for around two years. She criticised the Care Quality Commission which gave Orchid View a "good" rating in 2010 - a year before it shut.
"I question how this could be the case and I question whether the inspection that did take place was fit for purpose", Ms Schofield added.
She went on: "It's a heart-breaking case. We all have parents who will probably need care in the latter part of their lives."
And she said a cause for concern was that many people who worked at Orchid View are still working in the industry.
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