The Care Quality Commission (CQC) has kept Croft House, in Ossett, in special measures, having first highlighted serious failings at the venue in March.
Now inspectors' latest report on the home, which was caring for 54 residents at the time of their visit, quoted families' concerns over staffing levels.
It comes amid the huge shortage of social care staff across the UK, which is leaving elderly people without the support they need.
Providers are also struggling with rising costs.
In its report, published last week, the CQC quoted one family member as saying, "I do not think there are enough staff to look after (the residents). "Care staff are run ragged."
The feelings were corroborated by staff feedback, with one carer telling inspectors, "We're always understaffed". Another said, "We do our best but we can't be in two places at once."
The CQC praised staff for being kind and caring and said managers were open and honest with people when things went wrong.
However, a number of concerns were identified, including around cleanliness.
The report said: "There was an odour of urine in one part of the service and equipment was not always clean, for example, one person had a dirty falls mat."
Inspectors also said that gaps in the flooring in the dementia unit put people at increased risk of falls.
Leeds-based Countrywide Care Homes, which runs the venue, was contacted for comment, but has yet to respond.
Local Democracy Reporting Service