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z °U'" rt c� Report AInspeDate: <br /> San Joaquin County Environmental Health Department <br /> Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: S"09 <br /> r P (209)468-3420 <br /> www.siogv.org/ehd Program <br /> Element: <br /> Facility Name Address City Zip Code <br /> Versailles Salon and Day Spa 1010 n.central ave. Tracy 95376 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Erica Frese Initial Consult. <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). <br /> V=Violation C=Corrected On Site <br /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION(cont.) C <br /> El1 Autoclave:approved and effective-passed integrator E] E] 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and El <br /> sterilized PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> ❑ 5 Decontamination/sanitation area separated and supplied <br /> El Chemical used: <br /> aro riatel <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled,used,and disposed of E]a ro riatel El Wet contact time provided: <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> sterilized ❑ ® 26. Barriers used ❑ <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER HEALTH AND HYGIENE aseptically <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks,Needles etc approved and used correctly ❑ <br /> ® 11. Handwashing facilities properly supplied and accessible, ❑ ❑ 30 Cross-contamination avoided during all phases of El <br /> water procedure <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen trainingElEl31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14 Appropriate personal protective equipment available and ❑ ❑ 33 Workstation,surfaces,including chairs,armrests,etc.in ❑ <br /> used good repair <br /> CUSTOMERSICLIENTS ® 34. Permittregistration posted ❑ <br /> ❑ 15 Branding is completed with no other customers in <br /> rocedure area ❑ ® 35. Operation and employee training records present El <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> ® 18 Client records approved and available-Consent form ❑ ❑ 37. Permits obtained and available ❑ <br /> and questionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients I ❑ ❑ 41. ❑ <br /> Received b (Print): Erica Frese Received by(Signature): Phone: 209 275-9133 <br /> Specialist(Print): Benjamin Esotto,Sr REHS Specialist(Signature): ' Phone: 209 468-3178 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />