The Commission for Health Improvement has criticised a hospital trust, accusing it of not conducting checks on locum doctors.
CHI's clinical governance review report on the Royal Berkshire and Battle Hospital trust also warns that its operation of two separate risk-management systems is causing confusion among staff.
CHI investigators found that the trust had failed to implement a district audit report on the use of locum doctors which said there was a need to carry out checks and provide formal induction, both of which, it said, 'pose a clinical risk'.
Although the trust was praised for its 'positive culture change' and its services in elderly care, recruitment has also been identified as another cause of concern, according to CHI.
High living costs and more attractive pay in other sectors of the local economy for low-grade staff had created problems across the trust.
A spokesperson for the trust said that reforms were already underway through its action plan: 'The report was generally positive about the work of the trust. We are taking measures to ensure proper checks are carried out on locums and formal inductions do take place.'