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iOt''�U�/y C <br /> A ��a Body Art Inspection Report��, Date: August 11,2022 <br /> y I {. San Joaquin County Environmental Health Department Program <br /> j 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> 4 Record: PRO530664 <br /> "• r r' (209)468-3420 <br /> `,C�•%: :_-: .. x`'P,•' www.siogv.orq/ehd Program <br /> Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0530665 Eddy Reyes Sr. (BBP Ex 2-25-23 PRO537476 Marcos Adame(BBP Ex 7-20-23 <br /> PR0537907 Eddy Reyes Jr(BBP Ex 7-7-23 PR054569 Fabian Reyes(BBP Ex 5-20-23 <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)—Invoices and sterilization certificates were not available for the following <br /> needle cartridges: <br /> - Fabian Reyes' needles with the lot#1207CMLT <br /> -Eddy Reyes Jr.'s needles with the lot#C1215M1C-1 <br /> -Marcos Adame's needles with the lot#C0803RLT <br /> Provide EHD with an invoice and sterilization certificate for the needle cartridges mentioned above. <br /> 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste"or with the biohazard symbol <br /> and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br /> Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e)—The sharps container in the first room to <br /> the right(vacant room)was full and in need of disposal. Provide photographic evidence of an empty sharps container <br /> in the room,to the EHD. <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b)— <br /> The paper towel dispenser in Marcos Adame's procedure room did not contain paper towels. Ensure paper towel <br /> dispensers are stocked. Provide photographic evidence to the EHD. <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 consent form and the medical questionnaire did not include all for the <br /> information listed in Form B. Include the following information on the forms and provide an updated copy to the EHD: <br /> Consent Form <br /> -Description of procedure. <br /> Medical Questionnaire <br /> - History of herpes infection at the procedure site. <br /> -History of hemophilia or other bleeding disorders. <br /> -Other risk factors for blood borne pathogens. <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—All practitioners were <br /> trained on the IPCP for the current year, besides Marcos Adame. Ensure all practitioners are trained on the IPCP and <br /> practitioners sign the training record. Provide EHD with a current training record signed by Marcos Adame. <br /> Reinspection on/about: A reinspection fee of$156 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />