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Body Art InspectioReport Date: 3113 bo y. San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PP-0 5-1 11 S Y (209)468-3420 www-siow.ornlehd Program fi oR Element: /) C PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONERIARTIST NAME Thomas Shea(BBP exp.8/31/19)Permit and BBP Mackenzie Roman(BBP exp.6/19/20)Permit and BBP PR0537718 posted. PRO541390 posted Ramon Barrera(BBP exp. 1/23121)Permit and BBP PRO540634 posted. PRO537638 Sophollie Pak BBP ex 8/27/20 Permit and BBP posted. William Edgington(BBP exp. 11/14/20)Permit and PRO540005 BBP not posted PR0545506 Angelo Madrigal BBP exp. -new practitioner Observations and Corrective Actions: 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. 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, touch less dispenser that is readily accessible to practitioner. HSC 119314(b)— The faucet water did not turn hot for either of the two sinks,the hot water was left on for approximately 3 to 5 minutes. Repair the hot water issue immediately. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307.—The Bloodborne Pathogen Training Certificates(BBP)for Thomas Shea was not current. Provide EHD with a copy of a current BBP certificate from an approved course. 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. Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 EH-11/17