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qu Body Art Inspection Report Date: August 17,2023 a San Joaquin County Environmental Health Department Program j 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: SR0086434 (209)468-3420 www.siogv.org/ehd Program Element: 4103 PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME Nicole Barber(BBP exp.8/12/24 Observations and Corrective Actions: 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)—A sterilization certificate was not available for the piercing needles (brand and lot numbers were not on the needle packages) or for the Charme cartridges with the lot number E0025306. Provide EHD with a sterilization certificate for the needles mentioned above. If a sterilization certificate is not obtainable,then replace the needles. 8. Jewelry placed in newly pierced skin shall be sterilized prior to piercing or purchased presterilized. If purchased presterilized, sterile packs shall be discarded if integrity is compromised. Clean calipers shall be used and the skin marked using clean toothpicks and ink or a single-use marking pen. Sterilized instruments shall be stored in sterilization packaging or in sterilization equipment cartridge until time of use. Sterile instrument packs shall be evaluated before use and shall be discarded if integrity is compromised. HSC 119310—A sterilization certificate was not available for the jewelry. Provide EHD with a sterilization certificate for the jewelry, if a certificate is not obtainable then replace the jewelry. 18. 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 The medical questionnaire did not include all of the information listed on Form B. Include the following and submit a copy of the form to the EHD: -History of herpes infection at the procedure site. -History of allergic reactions to antibiotics. -History of hemophilia or other bleeding disorders. -History of cardiac valve disease. -Current medications. -Requirements for antibodies prior to surgery or dental procedures. -Other risk factors for blood borne pathogens. 18. 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—The client consent form for permanent cosmetics was not available for review. Submit a permanent cosmetics client consent form to the EHD for review. 18. 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—The client consent(piercing)forms did not include all of the information listed on Form B for the minor or adult. Include the following information on the consent forms and submit a copy to the EHD: -Description of what the client should expect following the procedure. 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in Form B. HSC 119308(b)—Aftercare instructions were not provided to the EHD for the permanent cosmetics. Provide a copy of the permanent cosmetics aftercare instructions to the EHD for review. Reinspection on/about: A reinspection fee of$162 per hour may be charged. Page 2 of 3 EH-11/17