A trouble-hit trust, accused of having a toxic culture, has had ratings for maternity services at two hospitals downgraded.
The Care Quality Commission (CQC) issued a warning notice for the service at Birmingham Heartlands Hospital and rated it inadequate.
The service at Good Hope Hospital in Sutton Coldfield now “requires improvement”.
University Hospitals Birmingham said it had worked to make improvements.
The trust, one of the largest NHS trusts in England, has been heavily criticised with repeated cases of bullying and a toxic environment being revealed in a report by Prof Mike Bewick, published in March.
Following a joint investigation by BBC West Midlands and Newsnight, it was revealed in December whistleblowers at the trust had said a climate of fear among staff was putting patients at risk.
An inspection of maternity services at both hospitals took place in February and the CQC has issued a warning notice to focus the trust’s attention “on rapidly making the necessary improvements” at Heartlands.
The maternity service there did not have enough staff to care for women and keep them safe, the CQC said.
The environment was in parts “not fit for purpose due to the lack of sufficient and suitable waiting space for women and birthing people”, the watchdog said.
Its report stated patients were not always reviewed in a timely manner in the pregnancy assessment emergency room, putting the safety of people “at risk”.
The CQC said over the past year the trust reported examples of care and treatment delays and managers did not always investigate incidents thoroughly.
But the maternity services “engaged well with women and birthing people within the diverse community, particularly with regard to Female Genital Mutilation… as well as a specialist bereavement service”.
The ratings for being safe and well-led at the Heartlands service also went down to inadequate, along with the well-led rating for maternity at Good Hope.
The service there provided maternity specific training in key skills, but did not always ensure everyone had completed it, and systems to “manage performance were not always used effectively”.
In a statement following the ratings at both hospitals, the NHS foundation trust said whilst the service was facing significant challenges in areas highlighted by the inspection, it had worked to make improvements.
These included expanding the pregnancy assessment emergency room and “improvements to staffing of the area”.
A spokesperson added: “This comes alongside a £4.7m refurbishment of the Princess of Wales Women’s Unit which is already under way.
“These improvements will continue under the leadership of a newly appointed Director of Midwifery.”
The trust said it was pleased areas of good practice had been highlighted by the CQC.
The watchdog said it saw how well staff worked with charities and at Good Hope people could reach call bells and staff responded quickly when called.