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�o: CCG <br />K � �� 2a <br />N, K <br />R r�i.::... N�,. <br />Body Art Inspection Report <br />San Joaquin County Environmental Health Department <br />1868 E Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />w.siogy.are/ehd <br />Element: 4120 <br />PR Number PRACTITIONER/ARTIST NAME <br />Date: May 12, 2021 <br />Program <br />Record: PR0544030 <br />Program <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0544033 <br />Rosalva Zavala <br />PR0544032 <br />Breanna Ostrander <br />PR0545109 <br />C stal A uirre <br />the EHD. <br />the instrument lot <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) —Sterilization certificates were not available for: <br />- Rosa's 1 RL Cartridge with lot #E0636806 (no brand name on package). <br />-Breanna's 1 P Cartridge with lot #90801 A. <br />-Crystal's blades with lot #BE04012019 (Bowler). <br />Provide a copy of <br />the sterilization certificates to the <br />EHD. <br />If sterilization certificates are not available then the <br />instruments shall <br />be replaced with instruments that <br />have <br />sterilization certificates. <br />11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br />paper towels dispensed from awall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) — <br />The sink in Crystal's room did not have hot water. Crystal will not be able to practice body art until the hot water is <br />fixed. Repair sink and call EHD for reinspection. <br />The paper towel dispenser in Crystal's and Rosa's room did not work. Repair dispensers. <br />Paper towels <br />were not in the paper <br />towel dispenser in Rosa's <br />procedure room. <br />Ensure the paper towel dispenser is <br />stocked with <br />paper towels. Provide <br />photographic evidence to <br />the EHD. <br />the instrument lot <br />The soap <br />container in <br />Rosa's procedure <br />room was empty. <br />Replace or fill <br />the soap container and provide <br />photographic <br />evidence <br />to the EHD. <br />the instrument lot <br />numbers are <br />written or <br />attached to <br />all <br />13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br />section 119307.—A current Bloodborne Pathogen Training Certificate was not available for Rosa, Breanna and Crystal. <br />Submit a current BBP certificate to the EHD for the practitioners. <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 —The medical questionnaire did not include all of the information listed in Form B, <br />for all three practitioners. Include the following on the forms and provide an updated copy to the EHD: <br />-Other risk factors for blood borne pathogens <br />The client records did not have a copy of the client identification cards attached. Ensure client records contain a copy <br />of the client's identification card. <br />Rosa's <br />client records did <br />not have the <br />instrument <br />(cartridge) <br />lot <br />number written <br />or the package attached to them. <br />Ensure <br />the instrument lot <br />numbers are <br />written or <br />attached to <br />all <br />client records. <br />Reinspection onlabout: A reinspection fee of $152 per hour may be charged. Page 2 of 3 <br />EH -11/17 <br />