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Body Art Inspection Report Date: August 19, 2022 <br />ySan Joaquin County Environmental Health Department Program <br />'/I 18BB E. Hazelton Ave., Stockton, CA 95205 Record: New PR# <br />(209)468-3420 <br />x .sioov.orn/ehd Program <br />3eFog�+Y Element: 4121 <br />PR Number <br />PRACTITIONER/ARTIST <br />NAME <br />PRO543461 <br />Kiara Guerrero BBP Exp <br />6/19/23 <br />Observations and Corrective Actions: <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0540594 <br />Kyle Thaw BBP Ex 9/5/21 <br />6. A facility that uses single use instruments shall maintain record of purchase, lag 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) —A sterilization certificate was not available for the Precision Needles <br />(Painful Pleasures) with the lot number 210515 and for Kyle Thaw's Cheyenne cartridge with the lot number 2021-19- <br />028. Provide EHD with the sterilization certificates for the instruments mentioned. <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 Kyle Thaw, Provide EHD <br />with a current copy of the practitioners BBP certificates. <br />18. The facility's 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 client records did not have photo IDs of the client attached and did not have <br />the lot number of the instruments attached/ written on the forms. Ensure client photo IDs are attached to the records <br />and lot number of the instruments used must be written or attached to the records. <br />Correct all observations and provide evidence of correction to the EHD by <br />September 5, 2022. <br />Notes: <br />1. Inspection report emailed to facility owner, Amanjit Dhanoya, at amansdhanoya@gmail.com. <br />2. Class V Integrators are not required to be in pouches and should be attached to the sterilization log. <br />3. Practitioner, Jose Carballo's fees have been paid and a current BBP Training Certificate was posted (expiration date 3/15/23). <br />4. Amanda Brown's permit is currently inactive. To reactivate permit, the practitioner must be with a permitted facility and pay a <br />registration fee of $156. <br />5. The Tuttnauer autoclave is approved by the EHD. <br />6. Ensure spore test is done on -a monthly basis. Keep records on site for a minimum of 3 years. <br />7. All new practitioners are to be trained on the Infection Prevention and Control Plan. Training records are to be kept on site for <br />3 years. <br />Reinspection on/about: A reinspection fee of $156 per hour may <br />be charged. Page 2 of 2 <br />EH -11/17 <br />