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Body Art Inspece Report • Date: ZA:7 /q <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 6"R Q OFO W F>'7 <br /> �c l (209)468-3420 Program <br /> {4,Fo r?i www.sjogv.org/ehd Element: <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Carrie Blubaugh <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and <br /> client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone <br /> sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. HSC 119315(f)—Provide sterilization certificate for needles/blades with appropriate lot <br /> numbers. <br /> 7. The sharps waste container shall be within arm's reach and labeled with the word"sharps waste" or with the biohazard symbol <br /> and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br /> Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) - Have sharps container within an arm's <br /> reach. <br /> 12. Practitioner shall provide evidence of current hepatitis B vaccination or hepatitis B immunity or comply with current federal <br /> OSHA hepatitis B vaccination declination requirements. HSC 119306(c)—Provide EHD with evidence of Hepatitis B <br /> vaccination or a Hepatitis B vaccination declination form. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. HSC 119303-Client consent form is missing the following statements: "inks are not FDA <br /> approved and health consequences are unknown." <br /> Medical questionnaire is missing the following statements: <br /> 1. History of herpes infection at the procedure site. <br /> 2. History of hemophilia or other bleeding disorders. <br /> 3. History of cardiac valve disease. <br /> 4. Current medications. <br /> 5. Requirements for antibiotics prior to surgery or dental procedures. <br /> 6. Other risk factors for blood borne pathogens. <br /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b) -Provide EHD with post-procedure instructions. <br /> 32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. <br /> The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to <br /> floor, from nail and hair activities and be separated from all business not related to body art. Approval of co-located body art <br /> facilites are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br /> procedure area shall have lined waste containers. HSC 119314 & 119317 Seal baseboards to floor. <br /> Notes: <br /> 1. Provide a copy of the IPCP to the EHD. <br /> 2. Provide a copy of the post-procedure instructions to the EHD. <br /> 3. Ensure a copy of the clients identification cards are maintained with their record. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />