There are still "significant concerns" about patient safety at a health trust placed in special measures last year, the health watchdog has found.
The Isle of Wight NHS Trust was rated "inadequate" by the Care Quality Commission (CQC) in April 2017.
The CQC said there had been "some improvements" but the trust would stay in special measures.
The trust's chief executive said it now "had the foundations in place" to improve.
The CQC's 2017 report found "unsafe" mental health services, widespread understaffing and a "subtle culture of bullying".
The island's ambulance service, mental health provision and the trust leadership were also criticised.
The latest report, following an inspection in January, gave the trust another overall "inadequate" rating.
It noted that doctors did not always complete safety checks in surgery, best practice was not always followed for infection control and mental health patients could not always access crisis services when they needed them.
However, it found staff were "dedicated and committed to patient care".
Analysis: David Fenton, BBC South health correspondent
This report looks at the whole of the healthcare system across the Isle of Wight, and its findings are not good.
It says there are significant concerns over patient safety and cites numerous examples - from doctors not following safety checks in operating theatres to staff failing to wash their hands properly.
The CQC has listed 233 instances where the NHS is failing its legal obligations to the island's 140,000 residents, and has to improve.
Some parts of the system, like critical care and outpatient service, were good, but overall the verdict is "inadequate", the lowest rating.
Despite this, the inspectors do seem to believe that the right changes can be made to turn the situation around.
Chief inspector of hospitals, Prof Ted Baker, said there was "a growing momentum and desire to improve" since last year's report.
"The trust has a new chair and chief executive in place who have started to build an experienced leadership team with the skills and abilities that are needed to provide the high-quality services that are required on the island.
"However, not all managers within the trust had the necessary experience at this stage to make the demonstrable impact on the quality and sustainability of services that was needed," he said.
"There are some areas where we still have significant concerns about patient safety."
The trust's chief executive Maggie Oldham said the recommendations would help with "implementing a plan for major improvement".
"We have always said that our improvement journey would not be an easy or a short one.
"It will take a lot of hard work... but we now have the foundations in place and I'm absolutely confident that we can and will deliver the services that our patients expect and deserve."