The trust that provides mental health and community health services across Staffordshire and Shropshire has been rated good overall.
It follows an inspection by the Care Quality Commissioner at Midlands Partnership NHS Foundation Trust on 19 February and 10 April.
It was given the same rating March 2016.
But now its been told it requires improvement regarding the effectiveness of services.
Inspectors say overall they found areas for improvement, including 15 breaches of legal requirements that the trust must put right.
Many of those issues relate to urgent care.
An inadequate rating has been given for how well-led that area is.
The report says the service did not have a strategy - though mangers felt it was difficult to work on one until the consultation process on its future was complete and they had direction from the clinical commissioning group.
It also suggested managers at all levels in the service did not always have the right skills and abilities to run a service providing high quality sustainable care.
Concerns were raised the service did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
The report says staff left patients potentially at risk, due to a lack of triage system to determine priority - but that has since been addressed.
The trust has also been ordered to ensure it reviews staffing and ways to improve recruitment and retention of staff, and that they have training in life support, recurring detailed sepsis awareness, manual handling, mental health, learning disabilities and dementia awareness.
In other areas, inspectors found examples of outstanding practice.
They say the quality of staff supporting patients living with dementia, especially those with behaviours that challenged, was consistently high, reflecting a personalised approach to care.
They also commended the mental health crisis and home treatment team in Stafford for its dedicated telephone number to patients for use within seven days of discharge, allowing patients to quickly reconnect with their key worker team if, in hindsight, they did not feel ready for discharge.
On wards for older people with mental health problems they said staff had been supported to review and analyse patient falls across the service and had updated risks assessments. Consequently, the number of patient falls had reduced.
Staff were also praised for treating patients with compassion, kindness, dignity and respect.
Inspectors found consistently high quality support for patients living with dementia.
They also highlighted the use of empathy dolls, reductions in unnecessary hospital admissions, personal behavioural support plans for patients being discharged, an end of life suite where family could stay, and an inter-generational therapy programme.
Neil Carr, Chief Executive of Midlands Partnership NHS Foundation Trust, said “this is an exceptional result for our staff.
"The organisation was less than a year old when the inspectors visited.
"I am particularly pleased to see that the CQC witnessed physical health care needs effectively addressed within the core mental health services.
"This is the single biggest reason for the merger of the two organisations; to create a single joined-up service around the service user and their family, reducing confusion, duplication and enabling better care co-ordination.”
"The report recognises that managers actively engaged with other local health and social care providers to ensure that an integrated health and care system was provided to meet the needs of the local population.
"I am pleased that our commitment to continuous quality improvement was also recognised. Over 1,000 members of staff have received training in quality improvement methods and we have set up an academy within the Trust to develop these skills even further.”