Patients are being cared for in the corridors of a hospital trust's emergency departments as "standard practice", a health regulator has said.
Patient privacy and dignity "remained compromised" at Worcestershire Acute Hospitals NHS Trust as a result, the Care Quality Commission (CQC) said.
In April, inspectors found "no tangible improvement in performance" since a previous assessment in November.
The trust, rated inadequate, said it had made improvements since then.
Worcestershire Royal Hospital, Kidderminster Hospital and Treatment Centre and Alexandra Hospital in Redditch are all run by the trust, which was placed in special measures in December 2015.
The report said caring for patients in the corridors in the emergency departments in Worcester and Redditch had become "institutionalised" and was standard practice.
Furthermore, the number of patients waiting between four and 12 hours to be admitted or discharged at the same units "remained consistently higher than the national average".
Areas requiring improvement:
- In the Worcester emergency department "time critical medications" were not always administered to patients who had been assessed as needing them on time
- Staff were not using privacy screens to respect patients' privacy and dignity in the emergency department corridor area in Worcester and Redditch
- There were insufficient numbers of consultants in the emergency department at Worcester and Redditch on duty to meet national guidelines
- In the paediatric ward in Worcester, one-to-one care for patients with mental health needs was not consistently provided by a member of staff with appropriate training
- The CQC said there was not "effective ownership of the need to establish effective systems to recognise, assess and mitigate risks to patient safety"
England's chief inspector of hospitals Prof Ted Baker said he had told the trust it "must make urgent improvements to the quality of healthcare" after its last inspection.
It has been subject to "rigorous and frequent regulatory action" over the last two years.
He said: "I remain concerned that the trust has not taken sufficient action to address the requirements of our previous inspections and patients using services continue to experience a poor level of care."
The trust said it fully accepted the shortfalls the CQC identified in its April inspection, but said the report published on Tuesday highlighted improvements.
These included better infection control procedures, while a review by regulator NHS Improvement found good hand hygiene.
The CQC also found staff were "hard-working, passionate and caring".
Audits were being undertaken to ensure missed medication was reviewed and by the winter it would have expanded its emergency care and medical assessment unit, the trust said.
Since May, it has recruited 43 consultants and doctors, with a further 34 doctors offered posts following a recent trip to India.
NHS Improvement said it fully accepted the CQC report findings and it was "working closely with the new executive team to address the issues raised".