Inspection·August 28, 2025

K0000 06/06/2025 A Fire & Life Safety revisit survey was conducted on 08/28/2025 via desk review at Clifford Chester Sims State Veterans Nursing Home, a nursing home in Panama City, Florida. This was a follow-up to the annual survey completed on 03/31/2025. All previously cited Fire & Life Safety deficiencies were corrected as of 6/7/2025. Office of Primary Care and Health Systems Management LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE | TITLE | (X6) DATE STATE FORM | Event ID: MSW8-L2 | Facility ID: 35960985 | If continuation sheet Page 1 of 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES PRINTED: 05/01/2026 FORM APPROVED OMB NO. 0938-0391 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONS (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: 106056 (X2) MULTIPLE CONSTRUCTION A. BUILDING 01 - MAIN FED B. WING (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER CLIFFORD CHESTER SIMS STATE VETERANS NURSING HOME STREET ADDRESS, CITY, STATE, ZIP CODE 4419 TRAM ROAD, PANAMA CITY, Florida, 32404 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETION DATE

K0000 Bldg. 01 INITIAL COMMENTS

K0000 A Fire & Life Safety revisit survey was conducted on 08/28/2025 via desk review at Clifford Chester Sims State Veterans Nursing Home, a nursing home in Panama City, Florida. This was a follow-up to the annual survey completed on 03/31/2025. All previously cited Fire & Life Safety deficiencies were corrected as of 6/7/2025. The facility was in compliance with Code of Federal Regulations (CFR) 42, Part 483.90 (a), Requirement for Long Term Care Facilities: Physical Environment. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: MSWB-L2 Facility ID: 35960985 If continuation sheet Page 1 of 1