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Body Art Inspection Report Date: April 29, 2022 N< San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: PRO537388 (209) 468-3420 w .siowore/ehd Program $[ r F o Pa Element: 4120 PR Number PRACTITIONER/ARTIST NAME PRO541881 Kevin Murphy BBP exp. 1/14/22 PRO546643 Kaitlin Kain(SEP exp. 10/7/22 PRO540841 Richard Rawlins (BBP exp. 4/6/23 5/9/22 PR0537415 Observations and Corrective Actions: PR Number PRACTITIONERIARTIST NAME PR0541300 Scott Bender (BBP exp. 10/7/22 li PR0544031 Jennifer Culotta(SEP exp. 5/9/22 PR0537415 Michael Carter (BBP exp. 1/31/23 is recorded on the client records rather than the word "guest". 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) —Sterilization certificates were not available for the XXX needle cartridges with lot numbers 21-07 and 19-05 or for the Cheyenne needle cartridges with lot numbers 202045-020 and 2020-50-096. Provide EHD with sterilization certificates for the mentioned cartridges. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307. — A current Bloodborne Pathogen Training Certificate was not posted for Richard Rawlin's or Kevin Murphy. Provide photographic evidence of posted certificates to the EHD. 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 — "Guest" was noted on client records instead of the name of the guest artist(s). Ensure the name of the guest artist(s) is recorded on the client records rather than the word "guest". 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 consent form (piercer) and medical questionnaire (piercer) did not include all of the information listed on Form B. Include the following on the consent form: Description of what the client should expect fallowing the procedure. A statement for using initials rather than a signature, such as "by entering your initials in the box below, you are effectively providing your signature..," Include the following on the medical questionnaire: -History of hemophilia or other bleeding disorders. - Other risk factors for bloodborne pathogens. 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 postprocedure instructions (piercer) did not include all elements listed on Form B. Include the following on the postprocedure instructions: -Signs and symptoms of infection. - Indications when to seek medical care. 32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to floor, from nail and hair activities and be separated from all business not related to body art. Approval of co -located body art facilities are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each procedure area shall have lined waste containers. HSC 119314 & 119317 —There are gaps between the door frame and the wall, in the sterilization room. Repair/ seal the door frame to the wall and provide photographic evidence to the EHD. Reinspection onlabout: A reinspection foe of $152 per hour may be charged. Page 2 of 3 EH -11/17