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".,'.," Body Art Inslation Report � date: /d/13I19 Q' 2 San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 3 R003Vf ion o P; (209)468-3420 Program c` www.s1ogv.org/ehd "< F�R Element: VJ I 0 3 PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME Laisin Saetern(BBP exp.9/29/20)BBP posted, PRO544903 permit not 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)—The sterilization certificate provided did not match the lot number on the cartridges and blades.Submit sterilization certificate for lot#19200404 and lot#E0636806. 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)—Documentation of sharps waste disposal by a licensed waste hauler or approved mail back system was not provided. Provide documentation of a licensed waste hauler or an approved mail back system that will be utilized. 9. No food, drink, tobacco product, or personal effects are permitted in the procedure area. HSC 119309—Tic tacs were observed in the procedure room. Ensure there is no food or beverages in the procedure area. 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 client consent form did not include all of the information listed in Form B. Include the following on the consent form: 1. Client is at least 18 years old 2. Description of what the client should expect following the procedure. 3. Notice that inks are not FDA approved and health consequences are unknown. 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in Form B. HSC 119308(b)—The medical questionnaire includes all the elements listed in Form B, but they are in a statement format and not in a question format. Edit the medical questionnaire to include all elements in a question format. 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)—The mapping pencils used in the facility are not single use. Do not reuse mapping pencils,obtain single use pencils. 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312—Health permit was not posted. Post permit in a conspicuous place. 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written Infection Prevention and Control Plan (IPCP)shall be maintained, followed and updated. HSC 119313 -Employee training record for the IPCP was not available. Train employees on the IPCP, provide evidence of training to the EHD. Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 EH-11/17