The home home near the city of Tula did not have basic safety equipment and police have started a criminal investigation into the latest in a series of fire disasters in Russia, according to officials quoted by Russian news agencies.
Regional deputy governor Alexei Korablyov said rescuers were trying to find five-to-eight people missing after Sunday's fire in Velye Nikolskoye, a village 30 kilometres (20 miles) outside Tula, ITAR-TASS reported.
More than 100 firefighters and 22 vehicles were sent to the blaze, where 293 people, including 17 nurses, were evacuated, Interfax news agency quoted the Emergency Situations Ministry as saying.
Viktor Beltsov, an official with the Emergency Situations Ministry, told Echo of Moscow radio station that flames had spread quickly through the 1950s-era building, which had wooden beams and no fire alarm.
According to Beltsov, authorities had tried to shut down the home after serious violations, including the lack of an alarm system, were discovered during three safety inspections over the last 12 months.
"However, the court did not support that decision," he said.
RIA Novosti news agency quoted a law enforcement source saying that an electrical short circuit started the blaze.
Police announced a criminal investigation into violation of fire safety procedures, news agencies reported.
Beltsov told Interfax that more people could have been saved if the fire services had been called earlier.
"The reason for mass death of people in the old people's home in Tula region was the delayed raising of the alarm," he said.
The deadly blaze was only the latest of a series in Russia, where accidents often end tragically due to poor safety procedures and infrastructure.
In December last year, a fire in a Moscow drug rehabilitation clinic killed 45 women.
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