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0�ouiN..c �� Body Art Inspection Report Date: September 1, 2021 N' < San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: PRO541156 (209) 468-3420 P w .sionv.orn/ehd Program �<r F o R�> Element: 4120 PR Number PRACTITIONER/ARTIST NAME PR0537718 Thomas Shea - BBP 7/8/22 PR0541390 Mackenzie Roman - BBP 6/19/20 PRO540634 Ramon Barrera - BBP 1/23/21 Observations and Corrective Actions: PR Number PRACTITIONER/ARTIST NAME PR0541191 Joel Me'ia - BBP 7/12/22 PR0537638 Sophollie Pak - BBP 8/27/20 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 Kwadron cartridge with lot number 1109 did not have a sterilization certificate. Provide EHD with a sterilization certificate for the cartridge mentioned. 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use paper towels dispensed from a wall -mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) - The paper towel dispenser in the procedure room did not have paper towels. Stock paper towel dispenser with paper towels and provide EHD with photographic evidence. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307. - A current Bloodborne Pathogen Training Certificate was not available for Sophollie Pak, Ramon Barrera and Mackenzie Roman. Provide a copy of current BBP Certificates for Sophollie, Ramon and Mackenzie to the EHD. 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and areavailable for inspection. HSC 119303- 1. Some of the client records did not contain a copy of the client's photo identification and none of the client records that were reviewed had the lot number of the needle/ cartridge written or attached to them. Ensure all records contain clients' identification and the lot number of the needle/ cartridge that was used. 2. The consent form did not include all the information listed on Form B. Include the following information on the consent form and submit a copy of the revised form to the EHD: - Description of what the client should expect following the procedure. 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 post procedure instructions did not include all of the elements from Form 8. Include the following on the form and submit revised form to the EHD: Restrictions on physical activities. Signs and symptoms of infection. Indications when to seek medical care. 32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to floor, from nail and hair activities and be separated from all business not related to body art. Approval of co -located body art facilities are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each procedure area shall have lined waste containers. HSC 119314 & 119317 - There is a gap in the floor near the entrance of the facility. Seal/ repair the floor and submit photographic evidence to the EHD. Reinspection EH -11/17 A reinspection fee of $15? per hour may be charged. Page Z of 3