Staff fell asleep while on duty at a mental health trust, inspectors found.
The Care Quality Commission (CQC) said it was "very disappointed" to find patient safety being affected by the same issues it had seen previously.
It said on acute wards for adults of working age and psychiatric intensive care units, five patients described staff falling asleep at night.
Despite CCTV being available, managers told the CQC they could not always immediately prove staff had been sleeping as accessing the pictures could take up to a fortnight.
The CQC report added trust data from June to December 2022 recorded 20 incidents of staff falling asleep while on duty but no action was taken because the video evidence had not been viewed.
Rob Assall, the CQC's director of operations in London and the East of England, said: "When we inspected the trust, we were very disappointed to find people's safety being affected by many of the same issues we told the trust about at previous inspections.
"This is because leaders weren't always creating a culture of learning across all levels of the organisation, meaning they didn't ensure people's care was continuously improving or that they were learning from events to ensure they didn't happen again."
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Source: BBC News, 12 July 2023