A warning notice has been issued to the Countess of Chester Hospital after its services were rated inadequate by The Care Quality Commission (CQC).

Urgent and emergency services at the hospital were again marked as inadequate, following an inspection with on-site visits in February 2025.  

It was carried out in response to concerns regarding the access, flow and care of people with mental health issues attending A&E, and how people are cared for in non-clinical areas like corridors.

Some of these concerns were substantiated. 

"When we inspected the urgent and emergency services, previous concerns still hadn't been addressed yet, which continued to place people at risk," said Karen Knapton, CQC deputy director of operations in the north.

"We have told leaders where we expect to see rapid improvements and will continue to monitor the service closely to keep people safe while this happens.

"We will return to check on their progress and won't hesitate to use our regulatory powers further if people aren't receiving the care they have a right to expect." 

Continued issues listed in the report include poor flow within the department and through to the wards, which was "still delaying discharges".

As a result, the report continued, it led to significant delays in people receiving treatment and their conditions "deteriorating as a result".    

The overall rating for Countess of Chester Hospital NHS Foundation Trust remains requires improvement.  

Its 'responsive' rating has improved from inadequate to requires improvement, 'caring' has gone down from good to requires improvement and 'well-led' has been rated as requires improvement again.  

Karen Knapton added: "People were sometimes held in ambulances for prolonged periods of time due to this limited capacity in the department.

"We also saw someone with suspected sepsis not receiving treatment according to national guidance placing them at risk of harm.  

"Staffing gaps combined with a very busy department meant people being cared for in corridor beds had become normalised. People with complex needs, such as those with learning disabilities or mental health conditions, often experienced even longer wait times resulting in an overall poorer experience. 

"Due to how busy the staff were, they were often task-focused and didn't always see when people needed additional support.

"For example, staff failed to act when someone with a learning disability became increasingly agitated in the waiting area, and didn't consider their needs or if any adaptations could be made for them to help them feel more comfortable."

The deputy director also outlined how the trust had failed to address CQC's previous concerns "regarding cleanliness of the department", which she explained placed people "at risk of infection".

Regular testing of equipment was also put into question.

Jane Tomkinson OBE, chief executive officer of the Countess of Chester Hospital NHS Foundation Trust, has responded to the report.

She said: "We are disappointed by the recent rating of our urgent and emergency care services by the CQC, following their unannounced inspection in February 2025.

"Whilst we have seen improvements, it is clear the actions taken in the last 12 months need to be enhanced to consistently deliver the experience and care our patients deserve. 

"During the inspection and on receipt of the warning notice we took immediate action.

"Our focus remains on addressing some long-standing challenges and we are committed to supporting our teams to ensure that the actions we take lead to sustainable improvements in our services.

"We will continue to work closely with our regulators and we anticipate a further inspection in due course where the improvements will be demonstrated."

Since the last CQC inspection in February, the trust has received £7.5 million to make improvements to the "environment of the emergency department".   

Some positive notes were also included, such as visible and supportive executive leaders - alongside encouraging staff development through various training and progression opportunities.

A visible and known wellbeing practitioner in the department was also cited, who can support staff during stressful periods.

The full report will be published on CQC's website in the coming days.