A Care Quality Commission inspection report on the emergency department at Medway Maritime Hospital concluded it was “effectively in a crisis situation”.

Medway Foundation Trust has been given two warning notices after CQC inspectors found a shortage of staff was “severely impacting” treatment, and the department was dirty in some areas.

The inspection took place on 31 December and was triggered by concerns sent anonymously to the CQC about care, cleanliness and infection control in the department.

Details were published today.

The inspection found 20 patients who had been waiting for more than four hours to be seen by doctors. Seven had been in the unit for more than 11 hours and one patient had been waiting more than 19 hours.

The hospital did not have enough cubicles and trolley bays to accommodate patients, and there was evidence of patients not receiving “basic care needs” while they were waiting. One elderly frail patient had been waiting on a trolley for more than 22 hours.

One patient had been waiting four hours for a blanket which had been requested. Another patient had not been offered any food or drink for 18 hours.

The department was unclean in some areas with “visibly dirty radiators and paintwork, stained floors and dirty wash hand basins; and blood spatters on a wall”.

Several members of staff described the department as “under siege”, and another told the inspectors: “I personally don’t think we are being supported; it’s a constant battle.”

The team saw medical and nursing staff were “working very hard to try to treat people appropriately”. However, there was insufficient staffing and capacity.

Staff reported that patients who had waited a shorter amount of time than others were to wards to avoid breaching the four hour waiting time target. There was concern medication was not being administered when required.

The inspectors said the department was “generally cluttered and untidy” with cages and boxes of equipment left stacked in corridors.

Responding to the report, the FT’s chief nurse Steve Hams apologised “for letting our patients down” and said: “The emergency department was designed to treat 50,000 patients a year, but now it is treating 90,000 and rising. We know it is not suitable for emergency and critical care in the modern world and are working hard to put it right.”

He said daily reviews of the department had been introduced, more staff had been recruited and an infection prevention and control team carried out weekly unannounced visits. The department is also being redeveloped.