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Body Art InspecOl Report • San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 (209) 468-3420 odt,;Fp�a`c www.siogv.org/ehd PR Number PRACTITIONERIARTIST NAME PR0544791 Lorlie T Observations and Corrective Actions: Date: 6 -VII Program �n o/'� r, IOV Record: j� V' V V I Program _ (II 103 Element: PR Number PRACTITIONERIARTIST NAME 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) — Provide record of purchase and evidence of sterilization for the purchased needles/blades to the EHD. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) —Provide a written agreement/contract with a licensed waste hauler or mail -back company. 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use paper towels dispensed from a wall -mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) — Provide a touchless paper towels dispenser that is wall -mounted in the procedure area and restroom. 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 — Provide an updated copy of the medical questionnaire to the EHD Medical questionnaire is missing the following statements: 1. History of herpes infection at the procedure site 2. History of allergic reactions to latex 3. History of allergic reactions to antibiotics 4. History of hemophilia or other bleeding disorders S. History of cardiac valve disease 6. requirements for antibiotics prior to surgery or dental procedures 7. other risk factors for blood borne 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)—After-care instruction is missing the following statements: "signs and symptoms of infection" and "indications when to seek medical care." Provide an updated copy to the EHD. 25. Disinfectant shall be used according to the manufacturer's instructions. HSC 119309(b) — Ensure that the surfaces remain wet for at least 30 seconds and 10 minutes for surfaces containminated with HIV. 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC Reinspecion onlabout: A reinspection fee of $152 per hour may be charged. Page 2 of 3 EH -11/17