Sun Behavioral Delaware LLC

“PATIENT RIGHTS CFR(s): 482.13 A hospital must protect and promote each patient’s rights. This Condition is not met as evidenced by: 48349 Based on review of facility policies, review of medical records, video surveillance, and staff interviews it was determined that the facility failed to protect and promote each patient’s rights as evidenced by failure to prevent unauthorized access to a medication room, and failure to record patients’ locations during routine observations accurately (A-0144). On November 8, 2024 at 1:10 PM, as a result of this failure, Immediate Jeopardy (IJ) was identified. The immediate interventions implemented by the facility included staff re-education, implementation of scheduled environmental checks, and leadership auditing. These interventions were implemented and verified by the State Agency, and the IJ was removed on November 12, 2024 at 9:40 AM. Cross Reference: 482.13(c)(2) Patient Rights: The patient has the right to receive care in a safe setting.”

“PATIENT RIGHTS: CARE IN SAFE SETTING CFR(s): 482.13(c)(2) The patient has the right to receive care in a safe setting. This Standard is not met as evidenced by: 48349 Based on review of hospital policies, review of hospital documents, review of medical records (MR), observations, and interviews with staff (EMP), it was determined that the agency failed to ensure a safe environment by leaving a medication room unlocked, and by failing to properly observe patients on the 2 West Unit. This deficient practice resulted in the hospital’s inability to protect patient rights and provide services in a safe setting. This deficiency had the potential to impact all 24 patients receiving inpatient care on the 2 West Unit. Findings include: Review of facility policy “Patient Rights”, effective October 2024, last revised July 2018, stated, “ ...Each patient shall receive care and treatment suited to the patient’s needs ...Each patient shall have the right to be free from ...neglect ...” Review of hospital admission packet provided to patients on admission included document titled “Patient and Family Information and Guidelines”, no date, which stated, “ ...Safety ...Safety Philosophy: The safety of all patients is the foremost staff concern and is the responsibility of everyone. All patients have the right to treatment in an environment that is safe and comfortable ...” Review of hospital policy “Levels of Observation and Precaution Levels”, Effective and Last reviewed May 2024, stated, “ ...All patients will be routinely observed in compliance with physician orders and prescribed protocols ...Q [every] 15 Minute Observations ...minimum level of observation for all patients ...Assigned staff will make direct visual contact with patients and confirm they are in no danger or distress ...” I. Unlocked medication room. Review of MR1 “General Note”, dated October 29, 2024 and signed by EMP13 (registered nurse), revealed, “ ...Approximately 3:54 PM, this writer notified a blanket disappearing out of the rear medication room door. This writer looked out into hallway to see, what later was determined to be, the patient at the end of the hallway behind the 2-West RN station. This writer asked the [Patient] if [he/she] had been in the medication room, because the door was having problems latching. The [patient] replied, “No” ...The writer closed the door and proceeded with medication pass. In the meantime, [EMP15] from maintenance examined the door latch, and discovered the latch plate was stuffed with a soft, white material, and covered with tape which was removed, and the door latch worked ...” Review of facility provided document “Investigation Summary”, revealed that an incident occurred on October 29, 2024, in which Patient #1 was able to gain access to the 2 West medication room. At 3:32 PM, EMP10 (nurse manager), notified EMP11 (supervisor), that the lock on the medication room on 2 West was not locking. At 3:41 PM, EMP10 (nurse manager) and EMP13 (medication nurse) both leave the unit. Patient #1 walked into the medication room at 3:48 PM and remained inside until 3:52 PM, attempting to break open a sharps container. Patient #1 exited through a rear door in the medication room and accessed a rear empty hallway, where he/she remained for a total of 47 minutes (3:52 PM until 4:35 PM). At 4:16 PM, tape and other materials were removed from the door lock plate. At 5:07 PM, additional items are removed from the door lock plate. Review of video surveillance from October 29, 2024, from 1:10 PM to 3:40 PM revealed the following timeline of events: 1:10 PM- Patient #1 sits in a chair close to the medication window and appears to be watching staff at the nursing station. 1:12 PM to 1:13 PM- Patient #1 drops to the ground and crawls on the floor towards the medication room, pausing briefly behind a pillar before reaching the medication room. Patient #1 then appears to examine the closed medication door. 1:42 PM - Patient #1 obtains tape from the nursing staff at the nursing station and goes to sit in a chair next to the medication room. 1:43 PM to 2:55 PM- Patient #1 can be seen frequently standing at the medication room door. View of the lock not visible as Patient #1 was standing directly in front of the locking side of the door, wearing a blanket. 3:05 PM- Patient #1 can be seen squatting next to the door, looking at the lock. 3:10 PM- Patient #1 walks back to the nursing station, receives 3 pieces of tape from nursing staff, and walks back to the medication room door where she remains for 5 additional minutes. 3:16 PM- Patient #1 pushes on the medication room door and walks away. 3:40 PM- EMP13 (medication nurse) leaves the medication room, and pulls the door closed. The door does not close properly, and EMP13 can be seen attempting to pull the door closed a few more times before walking away. 3:48 PM- Patient #1 enters the medication room and closes the door. Patient #1 makes multiple unsuccessful attempts to gain access to the locked sharps container that is secured to the wall. 3:51 PM- EMP13 enters the medication room and Patient #1 enters the back hallway through the rear medication room door. EMP13 enters the rear hallway and looks around. 3:52 PM- EMP13 re-enters the medication room, goes out to the main unit and then returns to the medication room with EMP6 (registered nurse), and they look at door. EMP13 then begins medication administration at 3:53 PM. 4:35 PM- Patient #1 is seen looking out the window of the door to the back hallway, and at that time, EMP12, EMP13, and EMP14 see Patient #1 and open the door to let her back onto the 2 West Unit. During an interview on November 8, 2024, between 11:20 AM and 11:30 AM, with EMP1, it was confirmed that multiple layers of leadership were aware that the door was not locking properly, however, no staff member was assigned to monitor the door until the issue was fixed. Staff knowingly left the medication door unlocked and unmonitored from 3:40 PM until 3:52 PM, in which time a patient was able to gain access. There was no staff within the line of sight of the medication room during the time the patient gained access. During an observation of 2 West on 11/7/2024 between 9:40 AM and 10:15 AM, it was observed, and witnessed by EMP2, that the lock plate for the medication room door had a visible sugar substitute packet shoved into the opening. During an interview on November 8, 2024, between 12:00 PM and 12:15 PM with EMP1, it was stated that the actions taken in response to the incident on October 29, 2024, included staff disciplinary action for appropriate staff members, as well as looking into alternate door options that would better a safer option for the unit. II. Patient observations Review of MR1 “Psychiatric Evaluation”, dated October 29, 2024, revealed that Patient #1 was ordered routine Q15 minute checks. Review of MR1 “Accountability Flow Sheet” for October 29, 2024, revealed that the observations indicated that Patient #1 was in the dayroom at 3:45PM, was outside at 4:00 PM, and was back in the dayroom for the 4:15 PM and 4:30 PM checks. Review of video footage indicated that from 3:48 PM until 3:52 PM, Patient #1 was in the medication room and from 3:52 PM until 4:35 PM, Patient #1 was in the back hallway alone and out of view of staff. The observations documented did not accurately reflect the location or status of the patient. Review of MR2 “Accountability Flow Sheet” for October 29, 2024, revealed that the observations indicated that Patient #2 was in the dayroom from 3:45 PM to 4:30 PM. Review of video footage indicated that on October 29, 2024, from 4:03 PM until 4:18 PM, Patient #2 was outside for a smoke break, accompanied by EMP12. The observations documented did not accurately reflect the location or status of the patient. Review of “Investigation Summary” for incident occurring October 29, 2024, revealed that another patient, Patient #2, was presenting herself as Patient #1 while Patient #1 was in the medication room and back hallway. The investigation summary confirmed that multiple Q15 minute observations were falsified for both Patient #1 and Patient #2. It was indicated that EMP12 did not confirm the identity of Patient #2 before going outside for a smoke break. During an interview on November 7, 2024, between 2:11 PM and 2:24 PM, with EMP1, it was confirmed that there was a failure to properly identify patients and a failure to document accurate patient observations. It was also confirmed that when documenting for each patient, the patient’s picture is shown on the tablet screen where documentation takes place.”

“PATIENT RIGHTS: RESTRAINT OR SECLUSION CFR(s): 482.13(e)(10) The condition of the patient who is restrained or secluded must be monitored by a physician, other licensed practitioner or trained staff that have completed the training criteria specified in paragraph (f) of this section at an interval determined by hospital policy. This Standard is not met as evidenced by: 44819 Based on review of facility policies and documents, review of medical records (MR), and interviews with staff, it was determined the hospital failed to properly monitor the condition of restrained patients for 1 of 2 patients (Patient # 1) sampled that were restrained. Findings include: Review of facility policy “Seclusion and Restraint” effective January 2018 and reviewed March 2024, revealed, “Assessment and monitoring...The RN [registered nurse] is responsible for assessment of the individual in restraint or seclusion...The RN or LVN/LPN [licensed vocational/practical nurse] will document...behavior and physical status of patient every (5) minutes...” A review of “Seclusion & Restraint/Emergency Medication Documentation” in the MR of Patient #1, dated 8/25/2024, revealed the patient was restrained with a physical hold on 8/25/24 from 8:00 PM to 8:36 PM. The document stated, “...Documentation must occur every 5 minutes, or more frequently as appropriate to the patient’s physical, emotional, and safety needs; or as the patient condition changes ...” There was no evidence that the patient’s behavior or physical status or that the patient’s physical, emotional, and safety needs were assessed during the entire length of the restraint period. During an interview on 8/30/24 at 1:41 PM, Employee # 1 confirmed there was no evidence that the patient’s behavior or physical status or that the patient’s physical, emotional, and safety needs were assessed during the entire length of the restraint period.”

“PATIENT RIGHTS CFR(s): 482.13 A hospital must protect and promote each patient’s rights. This Condition is not met as evidenced by: 48779 Based on observations, review of facility policies, review of facilty documents, review of medical records (MR), review of video surveillance, and interviews with staff (EMP), it was determined that the facility failed to protect and promote each patient’s right to be free of abuse/harrassment, which had the potential to negatively impact all 20 patients on the adolescent unit. (A0145). Cross Reference: 482.13(c)(3) Patient Rights: Free from abuse/harassment On 5/23/24 at 12:02 PM, as a result of this failure, Immediate Jeopardy (IJ) was identified. The immediate interventions implemented by the facility included stopping adolescent admissions, increase leadership review and auditing, and provider notification of every incident of physical assault for adolescent patients within 30 minutes of the incident to consider new orders or interventions. These interventions were implemented and verified by the State Agency, and the IJ was removed on 5/24/24 at 11:09 AM.”

“PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT CFR(s): 482.13(c)(3) The patient has the right to be free from all forms of abuse or harassment. This Standard is not met as evidenced by: 48779 Based on review of facility policies, review of facility documents, review of medical records (MR), review of video surveillance, and interviews with staff, it was determined that the hospital failed to keep patients free from physical abuse and harm on the adolescent unit. This failure had the potential to negatively impact all 20 out of 20 patients on the adolescent unit. Findings include: Review of facility document “Adolescent Welcome Handbook”, no date, revealed, “ ...The safety of all patients is the foremost staff concern and is the responsibility of everyone. All patients have the right to treatment in an environment that is safe and comfortable ...” Review of facility policy “Patient Rights” origination date July 2018, effective date July 2023, revealed, “...Each patient shall have the right to be free from... Abuse, mistreatment, and neglect ...” Review of facility policy “Levels of Observation and Precaution Levels” origination date January 2016, effective date May 2024, revealed, “...The physician shall order one of three levels of observation at time of admission... and may change level of observation if the patient’s condition warrants a change... The physician will order a specific safety precaution... The RN may increase the level of observation if the patient’s condition changes...Aggression Precautions...Special considerations will be given to room assignments and if possible the patient will have not have [sic] a roommate...” Review of facility document “Incident Log” for March 2024 revealed a total of two (2) reported incidents occurring on the adolescent unit that were categorized as either assault to peer, or assault by peer. Review of facility document “Incident Log” for April 2024 revealed a total of nine (9) reported incidents occurring on the adolescent unit that were categorized as either assault to peer, or assault by peer. Review of facility document “Incident Log” for May 2024 (from May 1, 2024 to May 22, 2024) revealed a total of twenty-eight (28) reported incidents occurring on the adolescent unit that were categorized as either assault to peer, or assault by peer. In an interview on May 22, 2024, between 10:45 AM and 11:23 AM, EMP1 stated this time of year has the highest volume of adolescent incidents. When asked what strategies were implemented to address this significant increase in peer to peer assaults, EMP1 stated that many of the kids are on 1:1 level of observation now, either the ones doing the violent behaviors, or the ones who are constantly on the receiving end. However, when asked about the current use of 1:1 level of observation on the adolescent unit, EMP1 stated that only one patient was currently on a 1:1 level of observation, and that was initiated within the last hour. EMP1 stated, “This is all new to us”. Patient #16 Review of MR16 “Face Sheet” revealed “...Admission Date 4/28/2024....Time 11:39 PM...Room 02144...Bed...A... Admitting Diagnosis... Major depressive disorder, recurrent, severe with psychotic symptoms...” Review of MR16 “Psychiatric Evaluation” dated 4/29/24 at 11:29 AM revealed, “...sees and hears things... reports a history of anger outbursts...problems to be addressed... Aggressive behavior... Level of Observation: Q [every] 15 minutes... “ Facility provided a document, “Incident Report”, that was submitted to State Incident Reporting Center. “Incident Report” revealed “... incident 5/10/24 at 9:36 PM... [Patient #16] got into a verbal altercation with [Patient #25] ...As staff were separating the two, [Patient #16] ran around staff and was able to assault [Patient #25] by punching him in the head... [Patient #25] had a raised reddened area to the posterior, lower side of the head...” Review of MR16 “Nursing Notes” dated 5/11/24 at 6:50 AM revealed “Rough evening as [he/she] reacted to another peer causing commotion, extensive talk by staff and...states...does not know what happened, doesn’t remember... “ Review of MR16 physician’s orders revealed patient was placed on Assault/Aggression Precautions on 5/11/24 at 12:50 PM, however Patient #16 remained with a roommate (Patient #22). Facility provided a document, “Incident Report”, that was submitted to State Incident Reporting Center. This document revealed “... incident on 5/15/24 at 9:20 PM ... [Patient #16] was experiencing auditory hallucinations and banging head on the wall... roommate [Patient #22] tried to stop [Patient #16] from injuring self and [Patient #16] grabbed [Patient# 22] around the neck in an attempt to choke [Patient #22] .... [Patient #16] was...placed on suicide/self-harm precautions in addition to recently added assault and aggression precautions...” Review of MR16 physician’s orders revealed “...5/15/24 at 9:20 PM....Seclusion and Restraint order... Patient reportedly responded to voices, was in room with roommate who attempted to talk and calm patient. Patient turned on roommate [Patient #22] and attempted to choke, roommate, [Patient #22] yelled which alerted staff, staff able to separate... [Patient #16] went into hall and attempted charging door, staff needed to place patient in a hold to stop...aggressive behavior... Patient remain [sic] sad/depressed, expresses...does not understand, that [he/she] ‘blacks out’ and reacts...”. Review of MR16 “Nursing Note” revealed...”5/15/2024 at 9:39 PM... Per roommate report, patient talked about increasing voices...is known to have auditory hallucinations, agitation increased to [Patient #16] placing hands around roommates [sic] neck, roommate alert and staff responded to break hold and attempt to de-escalate... agitation increased and patient needed to be placed in a hold @ approximately 2120 [9:20 PM]...” Review of MR16 revealed no evidence that a change in patient’s level of observation was considered or that Patient #16 was evaluated for a private room after the aggression/assault incidents on 5/10/24 and 5/15/24. These findings were confirmed with EMP10 on 5/22/24 at 3:30 PM. Inpatient census obtained on 5/20/24 revealed Patient #16 and Patient #22 were still roommates, five (5) days after Patient #16 assaulted Patient #22. Patient #16 was not assigned to a new room after the 5/15/24 incident when this patient attempted to harm his roommate. This finding was confirmed with EMP1 on 5/24/24 at 10:51 AM. Patient #17 Review of MR17 revealed that this patient was the victim of three (3) physical assaults and one (1) attempted physical assault by two different peers on May 20, 2024, from 12:35 PM to 3:30 PM. Review of MR17 “Face Sheet” revealed “...Admission Date: 5/12/2024 at 0119 [1:19 AM]...” Review of MR17 physician’s orders revealed “...5/12/2024 at 0543 [5:43 AM]... Observation Status: 15 Minute Observation Each Shift...” Assault #1 Review of MR17 “Nursing Note” dated 5/20/2024 at 12:35 PM revealed “...Pt was attacked by peer [Patient #20] on unit, patients were quickly separated. No hold for patient or medications administered...” Video surveillance of above incident, reviewed on 5/24/2024 at 11:27 AM, revealed Patient #17 sitting in a chair on the unit and is suddenly attacked by a peer (Patient #20) that enters the area. Assault #2 Review of MR 17 “Nursing Note” dated 5/20/2024 at 1:22 PM revealed “...Patient was attacked again at 1322 [1:22 PM] by a different peer [Patient #21] in the milieu, hit multiple times before staff was able to separate. No holds or medication administered. Guardian called, no answer, voicemail left. Supervisor...made aware...” Video surveillance of above incident, reviewed on 5/24/2024 at 11:27 AM, revealed Patient #17 is sitting on the floor talking to a peer. Patient #21 observed running fast towards the Patient #17 and hitting her/him. Attempted Assault #3 Review of MR17 “Nursing Note” dated 5/20/2024 at 1:45 PM revealed “...Pt was attacked by peer [Patient #21] on milieu, unprovoked, separated by staff quickly, no holds or medication administered. Pt states she has no injuries and no complaints at this time. Supervisor...made aware. MD... made aware. Father called and made aware...” Review of MR21 physician’s orders revealed Patient #21 was previously placed on Close Visual Observation (CVO) every shift on 5/20/2024 at 8:17 AM. However, Patient #21 was still able to assault or attempt assault of Patient #17. Assault/Aggression Precautions were then ordered on 5/20/2024 at 1:49 PM for Patient #21. Review of MR17 revealed Patient #17 was evaluated by a medical provider on 5/20/2024 at 2:07 PM. No additional orders were added to MR17. Video surveillance of above incident, reviewed on 5/24/2024 at 11:30 AM, revealed Patient #17 standing near the nurses’ station when Patient #21 runs fast towards Patient #17, but is stopped by a staff member. No physical contact occurs. Assault #4 Review of MR17 “Nursing Note” dated 5/20/2024 at 3:30 PM revealed “...Pt was attacked by the same peer [Patient #21] as earlier, unprovoked, pts were quickly separated, no holds or medications administered. Supervisor...made aware. MD... made aware. Father called, no answer, voicemail left...” Video surveillance of above incident, reviewed on 5/24/2024 at 11:44 AM, revealed Patient #17 sitting in a chair with a group of kids in the milieu. Patient #21, who is not sitting in the group of kids, runs quickly toward Patient #17, grabs Patient #17 by the hair, pulls Patient #17 out of the chair and onto the floor, and hit him/her approximately 4 times before staff intervenes and separates the patients. A review of MR17 revealed no evidence, after four (4) incidents of aggression/physical assault by peers, that additional interventions were considered to protect Patient #17’s safety. This finding was confirmed with EMP10 on 5/22/2024 at 3:01 PM. Patient #18 Review of MR18 “Face Sheet” revealed that patient was admitted to the hospital on May 8, 2024. Facility provided a document, “Incident Report”, that was submitted to State Incident Reporting Center. “Incident Report” from May 12, 2024, revealed that, at 6:49 PM, Patient #18 was punched in the head multiple times without warning by another adolescent patient (Patient # 26). Facility provided a document, “Incident Report”, that was submitted to State Incident Reporting Center. “Incident Report” from May 13, 2024, revealed that, at 7:51 PM, Patient #18 was sitting alone in the gym when another patient (Patient #27) began to hit them. The assailant was removed by staff. During this time, a total of three other adolescent patients (Patient #’s 28, #29, and #32) also punched Patient #18. Facility provided a document, “Incident Report”, that was submitted to State Incident Reporting Center. “Incident Report” from May 14, 2024, revealed that, at 8:39 AM, Patient #18 was attacked from behind by another adolescent patient (Patient #30). Before staff could intervene, two other adolescent patients (Patient #29 and Patient #31) also punched Patient # 18 multiple times. Review of MR18 physician’s orders revealed that the patient was previously ordered a 1:1 level of observation on May 12, 2024 at 11:34 AM, before the first incident. The order for 1:1 level of observation was discontinued on May 13, 2024 at 5:45 PM (about 2 hours prior to the second assault). No evidence of reason for discontinuation was located in MR18. 1:1 level of observation was next ordered on May 14, 2024 at 10:03 AM, after the third assault, with a reason listed as “Observation for Safety purpose”. Interview on May 23, 2024 at 3:00 PM with EMP11 confirmed that Patient #18 was only on a 1:1 level of observation during the first assault by peers. A review of MR18 revealed no evidence of additional interventions to maintain the safety of Patient #18.”

“SUPERVISION OF CONTRACT STAFF CFR(s): 482.23(b)(6) All licensed nurses who provide services in the hospital must adhere to the policies and procedures of the hospital. The director of nursing service must provide for the adequate supervision and evaluation of all nursing personnel which occur within the responsibility of the nursing service, regardless of the mechanism through which those personnel are providing services (that is, hospital employee, contract, lease, other agreement, or volunteer). This Standard is not met as evidenced by: 48349 Based on review of facility policy, review of medical record (MR), and interview with staff, it was determined that for 2 out of 21 patients (Patient #23 and Patient #24) in the sample, hospital staff failed to document elopement attempts in the medical record per hospital policy. Findings include: Review of facility policy “Nursing Documentation” origination date January 2016, effective date September 2023, revealed, “...Daily Nursing Shift Note/Assessment ...provides continuity of care on a 24-hour basis and is a valuable tool for all clinicians involved in the care of the patient ...Any significant findings and subsequent interventions in nursing re-assessment, including ...change in patient condition, medical or behavioral ...patient incidents ...elopements and returns shall be documented in the narrative section of the Daily Nursing Assessment. Notes shall state observed patient behaviors in simple descriptive terms ...” Review of MR23 “Daily RN Assessment note 7a-7p” dated May 22, 2024, indicated precaution orders for AWOL/Elopement. Order stated “AWOL/Elopement Precautions QSHIFT [every shift] ...pt [patient] pushed through unit door in attempt to exit unit”. No documentation to include the patient’s behavior, details of the elopement attempt, or subsequent nursing interventions was located in MR23. Review of MR24 “Daily RN Assessment note 7a-7p” dated May 22, 2024, indicated precaution orders for AWOL/Elopement. Order stated “AWOL/Elopement Precautions QSHIFT [every shift] ...pt [patient] pushed through door in attempt to exit unit”. No documentation to include the patient’s behavior, details of the elopement attempt, or subsequent nursing interventions was located in MR24. During an interview with EMP1, EMP2, and EMP3 on May 24, 2024 between 9:00 AM and 11:00 AM, it was confirmed there was no evidence of nursing documentation regarding the attempted elopements of Patient # 23 and Patient # 24 on May 22, 2024.”

“Psych Eval - Within 60 Hours CFR(s): [Each patient must receive a psychiatric evaluation that must--] Be completed within 60 hours of admission; This Standard is not met as evidenced by: 47821 Based on medical record review (MR), facility policy review, and staff interview, it was determined that for 1 of 21 patients (Patient #20) in the sample, the Hospital failed to have a psychiatric evaluation completed within 60 hours of admission. Findings include: Review of facility policy “Psychiatric Evaluation”, origination date December 2015, last revised May 2024, revealed “Each patient admitted...receives a psychiatric evaluation that must: Be completed and available to staff within 24 hours of admission.... contain a record of mental status. The mental status describes the appearance and behavior, emotional response, verbalization, thought content and cognition of the patient as reported by the patient and observed by the examiner at the time of the examination...Describe attitudes and behavior...Estimate intellectual functioning, memory functioning and orientation as well as how each were tested/assessed. Include an inventory of the patient’s assets in descriptive, not interpretive fashion...” MR20 Review of “Face Sheet” revealed “...Admitted on 5/16/24 at 11:07 PM... Admitting Diagnosis: Major depressive disorder, recurrent severe without psychotic features...” Review of “Psychiatric Evaluation” dated 5/17/24 at 3:43PM revealed, pages # 5, #6, #7 and part of #8 were not completed and were left blank. On Page 5, the following areas were blank, “...Appearance...Attitude...Motor Activity...Neuromuscular Integration...Speech...”. On Page 6, the following areas were blank, “Speech: (Continued)...Speech Other/Comments...Mood...Affect...Thought Process...Thought Content...Attention/Concentration...Orientation...Immediate Memory...Immediate Memory how tested...Remote Memory...Remote Memory how tested...Recent memory...Recent Memory how tested...” On Page 7, the following areas were blank, “Judgment...Judgment how tested...Insight...Insight how tested...Intellectual Functioning...Intellectual Functioning how tested...Assets/Strengths...Willingness to Participate in Treatment...Liabilities/Deficits...” On Page 8, the following areas were blank, “Liabilities/Deficits (Continued)...Psychiatric diagnosis...” This finding was confirmed with EMP10 on 5/22/24 at 2:41 PM.”