Inspectors have highlighted a shortage of critical care anaesthetists at a hospital.
The Care Quality Commission (CQC) visited Telford's Princess Royal Hospital after being contacted about the quality of its out-of-hours cover.
The hospital trust said a shortage of anaesthetists was a national issue it was working to address.
Shrewsbury and Telford Hospital NHS Trust has been in special measures since November 2018.
Inspectors focused only on the provision of out-of-hours anaesthetic cover.
Vacancies at the site meant there were not always enough skilled staff to carry out the right care and treatment, the report highlighted.
But the risks to patients had been mitigated with staff working across the trust's sites and by using general anaesthetic staff out of hours, it said.
Inspectors reported some anaesthetic staff did not always feel respected, supported or valued by senior staff and that some general anaesthetic consultants felt they did not have the up-to-date skills and knowledge to care for patients with more complex needs.
Examples of good care were also highlighted in the report, including effective leadership.
Dr Arne Rose, medical director at the trust, said: "We are grateful to the CQC for acknowledging that the leadership team is aware of current challenges and that we have improved and strengthened our process while we seek to address these."
The hospital's whole critical care provision was last inspected in 2018 and remains as "requiring improvement", said the CQC.
The NHS trust remains rated "inadequate overall", the report added.
The site, along with the Royal Shrewsbury Hospital also run by the trust, is at the centre of an independent review looking into maternity care provided to more than 1,800 families.