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�o°"�" Body Art Inspects Report .;•-,r- ..,tea 2 " San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 (209) 468-3420 c9< FOR`'�P www.siogv.org/ehd PR Number PRACTITIONER/ARTIST NAME PR0537718 Thomas Shea (BBP exp. 3/14/21 ) Permit and BBP posted. PRO540634 Ramon Barrera (BBP exp. 1/23/21) Permit and BBP posted. PRO540005 William Edgington (BBP exp. 11/14/20) Permit and BBP not posted Observations and Corrective Actions: Date: Program Record: RCC S 4 l l S 5' Program Element: H la CI PR Number PRACTITIONER/ARTIST NAME PRO541390 Mackenzie Roman (BBP exp. 6/19/20) Permit and BBP posted PRO537638 Sophollie Pak BBP ex 8/27/20 Permit and BBP posted. PR0545506 Angelo Madrigal BBP ex - new practitioner 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) —The sterilization certificate and invoice were not available for the cartridges/ needles used by Ramon Barrera and Sophollie Pak. Provide sterilization certificates and record of purchase for the Cheyenne cartridges/ needles with the lot # 2019-37-067 (Ramon) and lot # 2019-51-112 (Sophollie) to the EHD. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) — A written agreement or receipt was not available for the sharps waste disposal. Provide evidence of current sharps waste disposal by submitting a receipt to the EHD. 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HSC 119303 — Ramon and Sophollie's client consent forms were reviewed. The client consent forms do not have the cartridge/needle lot numbers attached or written on them. A few of the consent forms also did not have client picture identification attached. Ensure all client records are complete, attach or write the lot number of the cartridge/ needle used on the consent form. Ensure client identification is also attached to the consent forms. 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HSC 119303 — The medical questionnaire did not include all of the information listed in Form B, include the following on the medical questionnaire: - History of hemophilia or other bleeding disorders. - Requirements for antibiotics prior to surgery or dental procedures. - Other risk factors for blood borne pathogens. 19. At the completion of the procedure, the practitioner shall provide post procedure instructions that include all elements listed in Form B. HSC 119308(b) — The aftercare instructions did not meet the requirements of Form B, include the following on the aftercare instructions: - Signs and symptoms of infection. - Indication when to seek medical care. 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313 — An IPCP and training records were not available. Train staff on the IPCP and provide evidence to the EHD. Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 3 EH -11/17