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Body Art Inspeck Report Date: San Joaquin County Environmental Health Department Program k' 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: cSP,0 o `//-2 \\ ' (209)468-3420 www.sioay.org/ehd Program �'tFQu Element: Y/O 3 1�I�.. Jessica Hernandez: BBP posted 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)-Contact manufacturer, Perpetual,for sterilization certificates that indicate the corresponding lot number on the instruments purchased. 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)-Obtain a contract with a licensed waste hauler, and provide documentation. 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)- With the four stations, an additional sink would be necessary since one sink needed per two pracitioners. 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- In the consent form, please include that inks are not FDA approved and health consequences are unknown, also include lot number for instruments used in client records. In the medical questionnaire, include: history of herpes infection at the procedure site, history of allergic reaction to antibiotics, and history of cardiac valve disease. 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in Form B. HSC 119308(b)- Include in postprocedure instructions: signs and symptoms of infection, and indications when to seek medical care. 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC 119311(a)- Be sure to use single use products, using a toothpick and ink is an acceptable method. Notes: 1) Include a copy of the driver's license/identification in the client records. 2) Provide EHD with an updated copy of the Infection Prevention and Control Plan. 3) Provide EHD with documentation of the contract with a licensed waste hauler for sharps disposal. Correct all violations noted above prior to final inspection. Contact EHD to schedule final inspection. Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 EH-11/17