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BodyArt Inspect*Report <br /> PDate: e2I,aola0 <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: P rc 0 5.Z 137S <br /> (209)468-3420 <br /> � •;.Y Program <br /> gc,FR�` <br /> www.sioqv.org/ehd Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Linh Vu BBP and permit are posted(BBP exp. <br /> PRO521376 3/4/20 . <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and <br /> client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone <br /> sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. HSC 119315(f)—A record of purchase was not available for the needles. Provide the EHD <br /> with a record of purchase for the needles. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. HSC 119303—The medical questionnaire did not include all the information listed in Form B. <br /> Include the following on the consent form: <br /> - History of herpes infection at the procedure site. <br /> - History of allergic reactions to antibiotics. <br /> - Other risk factors for Bloodborne Pathogen. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Forth B, and are <br /> available for inspection. HSC 119303—The client consent forms were not complete.A client consent form dated 2/17/20 <br /> did not have the client's signature.All the client consent forms that were reviewed did not have the lot#of the needles <br /> written or attached to the form. <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313—The IPCP was not <br /> available during the inspection.A copy of the IPCP must be on site at all times. Update the IPCP to include the new <br /> business name and provide a copy to the EHD. <br /> All corrections are due by March 5, 2020. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />