A hospital has failed to make "significant improvements" in its care for older people despite previous concerns raised with management, a second inspection has found.
An initial inspection into acute care for older people in Galloway Community Hospital last November raised concerns about safety and record-keeping.
A report by Healthcare Improvement Scotland (HIS) identified a "disconnect between senior management and ward staff". It also stated that documentation of care provided to patients was incomplete in some cases.
Concerns were also raised about the "lack of willingness of medical staff to ensure that patients have the capacity to consent to treatment".
After the initial inspection, HIS asked the local health board, NHS Dumfries & Galloway, to conduct an internal review and create an action plan to address the issues identified.
An unannounced follow-up inspection of the hospital was held on January 7 and 8, and HIS officers said it "failed to identify significant improvement within the hospital".
NHS Dumfries & Galloway said the report was "very disappointing" and apologised for the standards of care.
The health board has now been told it must make significant improvements in 26 areas.
The recommended improvements include ensuring ward staff are clear in their responsibilities, better support and leadership from senior management in monitoring patient care and ensuring that the medicines policy is adhered to by staff at all times to reduce the risk of medication errors.
Jacqui Macrae, head of quality of care at HIS, said: "This inspection has raised concerns about patient care and safety at Galloway Community Hospital.
"During inspection in November, we identified issues where patient documentation had not been completed or had not been completed correctly. Therefore, we were not assured that the care being given was appropriate.
"We were also concerned about leadership and management, and found a lack of willingness from medical staff to ensure that patients had the capacity to consent to treatment.
"We referred this concern to the Mental Welfare Commission for Scotland.
"Due to our concerns regarding the quality of care being provided to patients, we asked for NHS Dumfries & Galloway to conduct an internal review of all patients in one of the hospital's wards.
"We also asked NHS Dumfries & Galloway to produce an action plan, detailing how immediate improvements would be made to address issues identified.
"To ensure improvements had been made and were in place, we returned to the hospital and carried out an unannounced follow-up inspection on Wednesday January 7 and Thursday January 8.
"During this revisit, despite an action plan being implemented by NHS Dumfries & Galloway, we failed to identify significant improvements.
"As such, we escalated our concerns to senior management within NHS Dumfries & Galloway. We also escalated our concerns to the Scottish Government.
"This inspection resulted in 26 areas for improvement which NHS Dumfries & Galloway must address as a matter of priority."
Galloway Community Hospital serves patients in Stranraer and the surrounding area. It has 46 staffed beds and a range of specialised care.
Jeff Ace, NHS Dumfries & Galloway's chief executive, said: "This is a very disappointing report and we apologise that we have been unable to demonstrate best standards of care.
"Whilst it is reassuring that the inspectors witnessed compassionate and skilled interactions between staff and patients, it is clear that we have much work to do to improve the consistency of record-keeping, care planning and delivery of best-care practice to patients with degrees of confusion or dementia.
"NHS Dumfries & Galloway has accepted all the recommendations contained within the report.
"Of these recommendations 15 were prioritised and had actions taken immediately, with the remainder aiming for completion before the end of March 2015.
"We have taken this report extremely seriously and are committed to continuing to work both with local staff and with Scottish Government advisers to ensure that we can demonstrate rapid and sustained improvement."
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