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Body Art Inspection Report <br /> �_• Z Date: November 9,2023 <br /> ly -� San Joaquin County Environmental Health Department Program <br /> 9 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0544020 <br /> (209)468-3420 <br /> .Cq,• •a�P� wwwsioay.orq/ehd Program <br /> F oR Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO542967 Fong Van BBP Exp.2/27/24 PRO543781 Lia Van BBP Exp. 11/7/24 <br /> PR0546032 Lee Sa Xion BBP Exp.8/12/24 PR0547765 Lizet Orozco(BBP Exp.5/9/24 <br /> PRO547605 Charlene Saetern(BBP Exp.9/9/24 <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of <br /> practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the <br /> instruments have undergone sterilization. The record of purchase, evidence of sterilization,type and number of <br /> instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) <br /> OBSERVATIONS: <br /> A sterilization certificate was not available for the Da Vinci cartridges (lot numbers 211201 and 230401), the Mast Pro needles <br /> (lot number 2)22-10-01) or the Mellie blades (lot number ME2306). <br /> CORRECTIVE ACTIONS: <br /> Provide EHD with sterilization certificates for the instruments mentioned above. <br /> 18. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, <br /> and are available for inspection. HSC 119303 <br /> OBSERVATIONS: <br /> Some of the client records did not have photo IDs attached. <br /> CORRECTIVE ACTIONS: <br /> Ersure photo IDs are attached to the client records for review. <br /> Correct all violations and provide evidence of corrections to the EHD <br /> by November 27, 2023. <br /> Notes: <br /> 1. Inspection •eport emailed to facility owner, Fong Vang, at fong.vang15(c_gmail.com. <br /> 2. The Infection Prevention and Control Plan and training records were available for review. <br /> 3. Facility is offering permanent cosmetics and tattoo procedures to clients. <br /> 4.An updated aftercare instructions for tattoo procedures was provided to the EHD. <br /> 5. Health permits and Bloodborne Pathogen Training Certificates were posted. <br /> 6. Only the front of the facility is used for body art procedures. <br /> 7. Sharps Assure is the medical waste mail-back system used by the facility. The sharps waste was last disposed on <br /> July 11, 2023 <br /> Reinspection on/about: A reinspection fee of$162 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />