Plymouth's hospital trust has been told to make urgent improvements following an inspection by the Care Quality Commission.
Derriford Hospital has been issued with two 'warning notices' requiring urgent action to improve the management of medicines and diagnostic services.
Overall the trust's rating remains at 'requires improvement'.
A team of inspectors visited the hospital in April and May this year, and their report is released this morning.
The inspectors found there were not enough staff within Derriford's pharmacy department to run a "safe or basic service".
On the week of the inspection there were between four and six pharmacists to cover the acute hospital, made up of 900 beds.
Diagnostic services were rated as 'inadequate'. Patients were waiting too long to gain access to services and there were unacceptable delays with imaging and the reporting of results, the report says.
"There were risks from ageing equipment and an environment that did not always respect patients’ privacy and dignity," it continued. "Patients were positive about the way staff treated them, although the staff themselves felt demoralised and unable to provide the service they wanted to deliver,
Surgery and outpatients were again rated as 'good', although both failed to meet demand for appointments and procedures against national standards.
The A&E department, the largest in the South West, is too small to safely accommodate the growing patient demand, the inspectors found.
Maternity services were rated as 'requires improvement overall', with concerns around equipment and medicines management.
Two 'warning notices' requiring urgent action to improve management of medicines within pharmacy services and ensure there were significant improvements in the diagnostic services.
Within the pharmacy service, there were not enough staff to ensure a safe or basic service
Patients were waiting too long to gain access to services and there were unacceptable delays with imaging and the reporting of results
Patients were positive about the way staff treated them, although the staff themselves felt demoralised and unable to provide the service they wanted to deliver.
The A&E department is the largest in the South West of England, and, as the trust acknowledges, is too small to safely accommodate the growing patient demand. Inspectors recognised the strong multidisciplinary team working in this busy department.
The systems for managing patients with mental health needs were not consistent across the trust and so care varied. There were also a number of vacancies for medical and nursing staff across the medical wards so staffing was not always at safe levels. However, well-led in medical care remained 'good'.