The Royal Cornwall Hospital has been severely criticised in a damning report by the Care Quality Commission.
A surprise visit in January found patients were waiting to be diagnosed, treated, admitted and discharged from the hospital in Treliske.
A year on from another highly critical report inspectors found there had been 'little sign of real improvement' at the hospital and said Cornwall deserved a 'better service'.
Inspectors found staff were very dedicated but were poorly managed and were dealing with very busy conditions.
Former vice-chairman of the RCH Trust Rik Evans described the report as 'appalling' and said he felt sorry for staff.
The current Chief Executive of the RCH Trust Kathy Byrne said the hospital was confronting the issues raised.
But she said the fact the inspection was carried out at winter when the hospital was more stretched could have impacted the CQC's findings.
Inspectors from the CQC will return in July looking for further improvements with a clear warning being made the hospital could be placed under special measures.