Meadowbrook Health: Environmental Safety Violations - GA
That was one of three insulin pens inspectors flagged on the B-Hall medication cart on January 28. A second pen, an insulin Aspart, had been opened on January 1 and marked with an expiration of January 31, meaning it had already been in use for 27 days by the time inspectors arrived and would expire in three days. Under manufacturer guidance, insulin pens are good for 28 days after opening. The pen was expired as of that visit. A third pen, an insulin Lispro KwikPen, had been labeled with an open date of January 28 and an expiration of February 5, a span of only seven days rather than the 28 days the manufacturer recommends. Whoever labeled it had calculated the window wrong.
All three pens were discarded on the spot.
The nurse on the cart that day, a Licensed Practical Nurse identified in the report as LPN BB, told inspectors she hadn't opened or labeled any of them. That was part of the problem. Multiple nurses cycle through the same carts because staff are frequently reassigned across units, she explained, and the pen that gets opened on one shift gets used on the next by someone who had nothing to do with labeling it.
LPN BB knew the standard. She told inspectors that once insulin comes out of the refrigerator, a nurse is supposed to calculate 28 days forward and write the expiration date clearly on the pen or vial. She acknowledged that hadn't happened with the pens in front of her. "Failure to properly date insulin could result in residents receiving ineffective medication," she said, according to the inspection report.
She also said she was not aware of any written policy at the facility that spelled out this requirement.
The expired dextrose turned up separately, in a different part of the building. During a review of the second-floor A/B/E-Hall medication room that same afternoon, inspectors found five floor-stock vials of 50% Dextrose injection, 25 grams per 50 milliliters, sitting in a box under the counter. They had expired in July 2025, six months earlier.
The unit manager, a Registered Nurse identified as RN AA, was present during the inspection. She confirmed the expiration dates and told inspectors she had not known the box was there. She removed and discarded the vials immediately.
Dextrose at that concentration is typically used in emergencies, administered when a resident's blood sugar drops to a dangerous level. Whether anyone had reached for that box in the months since it expired, the inspection report does not say.
The Director of Nursing, interviewed on January 30, described the system that was supposed to prevent exactly this. Unit managers are responsible for weekly checks of medication carts and daily checks of medication rooms. Nurses are required to verify the Medication Administration Record at least three times before giving any medication. Expired medications are to be identified and scanned back to the pharmacy promptly. Insulin pens must be labeled with both the date opened and the calculated 28-day expiration by the nurse who opens them. If a pen is found undated or expired, it must be discarded.
The DON said that use of expired medications may be harmful to residents and that potential side effects are unknown.
The gap between that policy and what inspectors found on January 28 was not subtle. The dextrose had been sitting in a box under a counter since at least July. The insulin pen with no date at all had been in open use with no one able to say when it left the refrigerator. The pen with the wrong window had been mislabeled by whoever opened it. The pen that was already past its 28-day limit had one day left before it hit the expiration written on its side, and by the manufacturer's count it was already there.
The facility's own reference guide from Omnicare pharmacy, dated 2025, states that all vials, cartridges, and pens should be dated upon opening. The facility's internal medication storage policy, revised in October 2024, states that outdated or deteriorated drugs shall not be used and must be returned to the dispensing pharmacy or destroyed.
Tucker Park Crossing is located at 4608 Lawrenceville Highway in Tucker. The inspection was a complaint survey. CMS cited the facility under Tag F761, covering medication storage, at a harm level of minimal harm or potential for actual harm, with few residents affected.
The residents on the B-Hall medication cart who received insulin from those pens in the days and weeks before the inspection — the diabetic residents whose doses were drawn from a pen no one had dated, or one that had already passed 28 days — received medication whose potency no one at the facility could verify.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Tucker Park Crossing of Journey LLC from 2026-01-30 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 5, 2026 · Our methodology
Tucker Park Crossing of Journey LLC in TUCKER, GA was cited for violations during a health inspection on January 30, 2026.
That was one of three insulin pens inspectors flagged on the B-Hall medication cart on January 28.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.