The health watchdog has taken action after an inspection at a hospital brought up a "number of concerns" surrounding its A&E department, particularly with regard to whether staff were identifying patients with suspected sepsis effectively.
The Care Quality Commission (CQC) said inspectors also found that care records were not always written and managed in a way that kept patients safe at Russells Hall Hospital in Dudley, West Midlands.
Some staff raised concerns regarding the leadership style of some of the executive team, speaking of a poor culture and working environment.
The CQC report inspectors raised issues with the review of deaths within the emergency department after finding that staff involved in the care of patients were able to undertake their own reviews of deaths.
In a number of cases, robust mortality reviews had not been undertaken, with an example of this given as a patient who had died after being placed in a triage category which indicated that they should be seen immediately and was placed back in the waiting room.
However, the mortality review did not identify this issue.
As a result of the inspection on June 28, the CQC said it has taken action to vary conditions on Dudley Group NHS Foundation Trust's registration.
The trust was already rated as "requires improvement" following previous concerns.
Heidi Smoult, deputy chief inspector of hospitals in the Central region, said: "We have had ongoing concerns about the emergency department at Russells Hall Hospital and were extremely concerned at what we found during our inspection.
"Patients were not being consistently assessed in a safe way, in particular, whether staff were identifying patients with suspected sepsis effectively.
"As a result of this we have varied conditions on the trust's registration, meaning it must provide regular updates to CQC surrounding staffing, triage of patients and its management of sepsis.
"Inspectors returned to the department in August to carry out a further inspection and a full report of this inspection will be published in due course. Meanwhile, we continue to monitor the trust extremely closely.
"The trust knows what it must do to ensure people receive the care they should be able to expect and we will return to check on whether sufficient improvements have been made."
In April it emerged that inspectors were forced to intervene to help a patient with suspected sepsis at the hospital after staff failed to properly monitor and treat them after they were admitted.
The CQC also said it was concerned by a lack of safety and leadership in the unit and rated its services "inadequate".
Senior clinicians deliberately left blood oxygen saturation readings off a national scoring system used to quickly identify acutely ill patients, inspectors were told.
When these findings were highlighted to the trust, one consultant said "it would trigger too many medical emergency calls" if they were included, the CQC report said.
Copyright (c) Press Association Ltd. 2018, All Rights Reserved.