University College Hospital London Foundation Trust has been issued with four compliance actions following a new-style Care Quality Commission inspection.

The compliance actions relate to a lack of full completion of the World Health Organization surgical checklist, the safety of the accident and emergency department, the recording of care assessments and records management on acute medical wards.

During the inspection in November the team found that the trust’s services were “safe, effective, caring, responsive to patients’ needs and well-led”.

While inspectors found a “strong consultant presence in surgery” they also felt there was a “risk of unsafe surgery as the WHO surgical safety checklist was not always fully completed”.

They also found that while A&E staff were committed to delivering good care, they were working in “very difficult circumstances”.

The report said: “Due to shortage of space, facilities and equipment and patients’ privacy and dignity [were] severely compromised.”

The inspection team also found that the trust was receiving a large number of patients through A&E rather than directly to a clinical area, a factor which was making the situation worse.

“In failing to address these issues we found trust leadership in A&E needed to be strengthened and improved,” the report added. “We believe the trust should take action to alleviate those pressures.”

The maternity unit, intensive and critical care services and children’s care were all praised by the inspection team.

In medical care, the team found examples of “excellent interaction with patients”. However, written nursing assessments, care plans and care delivery records were sometimes “insufficiently completed”.

The report said: “Although we saw no evidence of unsafe care being delivered, insufficient recording meant there was an increased risk of inappropriate or unsafe care or treatment.”

The team also saw evidence of “inadequate management of outpatients clinic which led to overcrowding and patients left without seating at busy times”.

Chief inspector of hospitals Sir Mike Richards said: “Our judgement is that this is an excellent hospital in many ways – but the failings we identified are preventing it from achieving excellence across the board. The trust has told us it is taking action – and we expect to return in due course to find that the problems have been fixed.”

He added that the A&E “wasn’t really fit for purpose – despite the staff there working hard to deliver safe care in difficult circumstances”.

UCLH chief executive Sir Robert Naylor said: “We are pleased that the inspectors recognised the commitment of our staff to delivering the best possible experience for our patients. We are proud that they found many examples of good care and teamwork.

“As a dynamic learning organisation committed to constant improvement we take very seriously the opportunities identified for learning in this report and will deal quickly and effectively with any areas where we have fallen below the highest standards.

“Work had already begun to improve our performance in the areas identified by the CQC prior to their inspection and this report will provide us with an additional incentive to address them immediately.”