Inspectors say there's only been "limited" improvement at Forth Valley Royal Hospital - and more work needs to be done.
It's the third time this year Healthcare Improvement Scotland have visited the site, amid "serious" concerns.
A report says the hospital is experiencing "extreme" pressures.
The health board was placed into special measures by the Scottish Government last month.
Speaking of the report, Donna Maclean, Head of Service, Healthcare Improvement Scotland, said:
“At the time of our follow-up inspection, NHS Scotland continued to experience a range of pressures including increased hospital admissions and reduced staff availability.
“We observed Forth Valley Royal Hospital experiencing extreme pressures from increased patient numbers, delayed discharges and high levels of staff absence. This report highlights our concerns on the limited improvement and in some cases a deterioration in safe delivery of care since our April 2022 inspection. This resulted in us formally escalating our concerns to Scottish Government in line with our escalation process. Many of our concerns were directly related to the safe delivery of care, particularly in the emergency department and admission units where many patients did not appear well cared for.
“We did, however, observe good communication and mutual support within the staff teams in many ward areas. In some ward areas staff appeared well organised with evidence of good team working however, many staff expressed concerns to inspectors related to the standard of care they were able to provide under the current system pressures.
“Our findings have highlighted serious patient safety concerns and have resulted in a further 11 requirements, to support NHS Forth Valley in the safe deliver of care. These have been added to the outstanding requirements that have not yet been achieved from the April 2022 inspection."