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Body Art Inspec eport 40 Date: <br /> San Joaquin County Environmental Health Department Program rlu <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 5960 "()9U 2 <br /> (209)468-3420 Program <br /> 9f <br /> www.siogv.org/ehd Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONERIARTIST NAME <br /> PRO541639 Kristen Patterson-Cranford <br /> PRO541640 Gayle Witt <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log 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)—Provide sterilization certificate for needles(lot number: 18111233 and <br /> 018091233). <br /> 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste"or with the biohazard symbol <br /> and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br /> Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e)—Maintain sharps waste disposal <br /> manifest. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. HSC 119303—Client consent form is missing the following statements: "inks are not FDA <br /> approved and health consequences are unknown" and "permanent nature of the procedure." <br /> Medical questionnaire is missing the following statements: <br /> 1. History of herpes infection at the procedure site <br /> 2. History of allelrgic reactions to latex <br /> 3. History of allergic reactions to antibiotics <br /> 4. History of hemophilia or other bleeding disorders <br /> 5. History of cardiac vavle disease <br /> 6. Requirements for antibiotics prior to surgery or dental procedures <br /> 7. Other risk factors for blood borne pathogens <br /> 32. A body art facility shall have floors,walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. <br /> The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to <br /> floor, from nail and hair activities and be separated from all business not related to body art. Approval of co-located body art <br /> facilites are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br /> procedure area shall have lined waste containers. HSC 119314& 119317—baseboards need to be seal to the floor. <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP)shall be maintained, followed and updated. HSC 119313—Maintain a copy of the <br /> IPCP at the facility at all time. Review the IPCP annually and sign and date after reviewing it. <br /> Notes: <br /> 1. Provide a updated client consent form and medical questionnaire to the EHD. <br /> 2. Provide sterilization certificate to the EHD. <br /> Correct violations prior to final inspection and all applicable fees. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />