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etN <br />Body Art Inspection Report <br />Date: November 15, 2021 <br />y' San Joaquin County Environmental Health Department Program <br />1868 E. Hazelton Ave., Stockton, CA 95205 Record: PR0541621 <br />(209) 468-3420 <br />• � _avP • w .sioov.om/ehd Program <br />Element: 4120 <br />Facility Name Address City Zip Code <br />Versailles Salon 1010 N Central Ave. Tracy 95376 <br />Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br />Erica Green-Ffese 6/30/22 Routine <br />The <br />above <br />facility is <br />inspected <br />for compliance <br />with Division 104, <br />Part <br />15, Chapter 7 of California <br />Health <br />and <br />Safety Code <br />(HSC) <br />22. <br />Parts replaced between clients -grommets, elastic bands, <br />Eletc. <br />V = Violation <br />C <br />= Corrected On Site <br />V <br />CLEANING AND STERILIZATION <br />C <br />V <br />MACHINE SAFETY AND SANITATION cont. <br />C <br />El1. <br />Autoclave: approved and effective - passed Integrator test <br />El <br />El <br />22. <br />Parts replaced between clients -grommets, elastic bands, <br />Eletc. <br />El <br />2' <br />Items washed, disinfected, packaged, labeled, and <br />❑ <br />sterilized <br />PREVENTING CROSS -CONTAMINATION <br />❑ <br />3. <br />Autoclave loaded correctly/packages allowed to dry <br />❑ <br />❑ <br />23. <br />Workstation/procedure area decontaminated <br />❑ <br />❑ <br />4. <br />Integrators used/monthly spore test/log maintained <br />❑ <br />24. <br />Appropriate chemical disinfectant used <br />El <br />ElE] <br />5' <br />Decontamination/sanitation area separated and supplied <br />❑ <br />Chemical used: <br />app ro riatel <br />® <br />6. <br />Invoices and log kept for disposable, pre -sterilized <br />❑ <br />25. <br />Disinfectant used appropriately/sufficient contact time <br />e ui meni <br />Elappropriately <br />❑ <br />TElElWet <br />Sharps containers labeled, used, and disposed of <br />contact time provided: <br />❑ <br />8 <br />Jewelry, tattoo and piercing equipment - clean and <br />❑ <br />❑ <br />26. <br />Barriers used <br />❑ <br />sterilized <br />PRACTITIONER HEALTH AND HYGIENE <br />❑ <br />27. <br />Products applied to skin are single use/dispensed aseptically <br />❑ <br />❑ <br />9. <br />No eating, drinking or smoking - clean clothes <br />❑ <br />❑ <br />28. <br />Storage of inks, pigments, needles, tubes, etc. <br />El <br />10, <br />Hands washed effectively and timely <br />❑ <br />❑ <br />29. <br />Jewelry, Inks, Needles etc approved and used correctly <br />El <br />Handwashing facilities properly supplied and accessible, <br />]EI <br />[130. <br />Cross -contamination avoided during all phases of procedure <br />101 <br />warm water <br />❑ <br />12. <br />Hepatitis B vaccination <br />❑ <br />BEST BUSINESS PRACTICES <br />Bloodborne Pathogen training <br />Areas separated/no living or sleeping quarters <br />❑ <br />El <br />ElEl31. <br />El <br />Source: <br />0 <br />32. <br />Floors and walls clean and in good repair, adequate light <br />❑ <br />El <br />14. <br />Appropriate personal protective equipment available and <br />El <br />❑ <br />33. <br />Workstation, surfaces, including chairs, armrests, etc. in <br />❑ <br />used - <br />good repair <br />CUSTOMERS/CLIENTS <br />❑ <br />34. <br />Permittregistralion posted <br />❑ <br />El <br />15. <br />Branding is completed with no other customers in <br />El <br />El <br />35. <br />Operation and employee training records present <br />El <br />rocedure area <br />❑ <br />16. <br />Customers eighteen (18) years of age or older <br />❑ <br />COMPLIANCE AND ENFORCEMENT <br />❑ <br />17. <br />Skin adequately prepared for procedure <br />❑ <br />❑ <br />36. <br />Plan(s) submitted for review <br />❑ <br />❑ <br />18. <br />Client records approved and available - Consent form and <br />El <br />El <br />37. <br />Permits obtained and available <br />❑ <br />questionnaire <br />❑ <br />19. <br />Appropriate aftercare instructions given to client <br />❑ <br />❑ <br />38. <br />Impoundment <br />❑ <br />MACHINE SAFETY AND SANITATION <br />❑ <br />39. <br />Hearing scheduled <br />❑ <br />❑ <br />20. <br />Safe machine design <br />❑ <br />❑ <br />40. <br />Closure <br />❑ <br />❑ <br />1 21. <br />Machines cleaned and disinfected between clients <br />❑ <br />❑ <br />41. <br />❑ <br />Received by (Print): Erica Green-Frese Received by (Signature): Emailed Phone: 209-275-9133 <br />Specialist (Print): Sandip Singh Specialist (Signature): s <br />9¢�y�j,d�Phone: 209-468-3526 <br />Reinspection on/about: <br />A reinspection fee of $152 per hour may be charged. Page 1 of 2 <br />EH -11/17 <br />