Health watchdogs have issued a formal warning to a Norfolk hospital after it failed its second inspection in five months.

Inspectors from the Care Quality Commission (CQC) first investigated the quality of food and how patients were being treated at James Paget University Hospital in April this year.

A report stated the quality of food was below acceptable standards, and an unannounced follow-up inspection on September 1 found the hospital had not made sufficient improvements.

The CQC has now issued a warning notice to the hospital, meaning it could be prosecuted, have services restricted or even be closed down if significant improvements are not made.

Frances Carey, regional director for CQC in the East of England, said: 'We were very disappointed that when our inspectors returned to James Paget Hospital they did not see enough improvement in relation to the food and drink people receive.

'Proper nutrition and hydration is an important part of recovery, especially for elderly people.

'We will be making another unannounced visit to the hospital shortly and, when we do, we will expect the trust to be able to demonstrate it has made significant improvements.

'If we find the required progress has still not been made, we won't hesitate to use our legal powers to protect the people who use this service.

'We have a range of enforcement powers which can be used, including prosecution, closure, or restriction of services. '

CQC inspectors noted that the hospital had begun to make improvements, but was still not meeting the required standards.

Wendy Slaney, chief executive of James Paget University Hospital, said: 'There is still work to do to get it right for all our patients and we are working on a programme of initiatives to ensure the required improvements are made.'

She said many of the issues raised by inspectors were to do with the organisation and delivery of meals to patients. The hospital has now implemented a completely new system for meal delivery, with meal coordinators ensuring that patients get the support they need.

Staff then speak to patients after each meal to ensure their experience was as it should be and to take action where issues arise.

'We are focussed on getting this right in the interests of all our patients with an expectation that when the CQC returns we will meet their requirements,' said Ms Slaney.

CQC inspectors, along with a practicing nurse and an 'expert by experience' made unannounced inspections to 100 NHS hospitals in April.

Their remit was to check whether elderly people were treated with dignity and respect, and were receiving food and drink that met their needs.

The full national report on findings from the inspection programme will be published in October.