COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SAN J OAQU I N Environmental Health Department r` U U 1\I 1 Y Body Art Inspection Report Facility Name : Facility Address : Date : AUTHENTIC IMAGES TATTOO & PIERCING 2139 JACKSON AVE , ESCALON 77IJune 25 , 2021 OBSERVATIONS AND CORRECTIVE ACTIONS Item # Remarks 18 HSC 119303 Client records approved and available - Consent form and questionnaire . The facility ' s client consent form and medical questionnaire must include all of the information listed in Form B , and are available for inspection . HSC 119303 1 . The client consent form and medical questionnaire did not include all the information from Form B . Include the information below, then provide a copy of the forms to the EHD . Include the following on the consent form : - Description of what the client should expect following the procedure . Include the following on the medical questionnaire: - History of herpes infection at the procedure site . - Other risk factors for blood borne pathogens . 2 . The client records did not have the client photo identification attached or the lot # of the instrument that was used . Ensure the client' s identification is attached to the client' s record and that the lot # of the instrument used is either written on the record or attached to it. Overall Inspection Comments : OBSERVATIONS Bloodborne pathogen training source : Body Art Training Group Chemical disinfectant used : Cavicide Wet contact time : 2 mins ON SITE PRACTITIONERS PR0546104 -- Alcira Padilla-Vega BBP exp . 6/4/22 NOTES Unless otherwise noted , correct all violations and submit corrections to the EHD by July 9 , 2021 , 1 . Inspection report was emailed to the facility owner, Alcira Padilla-Vega , at authenticimages18@gmail . com . 2 . Update the Infection Prevention and Control Plan to include the disinfectant , Cavicide . The wet contact time is 2 minutes to eliminate HIV, HBV and HCV . 3 . Sharps Solution is used for sharps waste disposal . Sharps waste has not been disposed since facility has opened . 4 . Practitioner informed to dispose of sharps waste when the container is full or once annually if the container is not full . 5 . A sterilization certificate was available for the jewelry with lot #A5654 , 14G . THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD ' S CURRENT HOURLY RATE . Received by : Date : June 25 , 2021 Inspector: Inspector Phone: EmAtiLM Printed Name and Title: SANDIP SINGH , EH Specialist (209 ) 468-3526 FA0026071 PR0546103 SCO01 06/25/2021 EHD Rev. 6/15/2021 Page 3 of 3 Body Art 0IR 1868 E . Hazelton Avenue Stockton , California 952051 T 209 468 -3420 1 F 209 464 -0138 1 www . sjgov . org / EHD