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Body Art Inspection Report Date: May 14,2021 y � San Joaquin County Environmental Health Department Program 1 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: SR0083667 (209)468-3420 www.slogv.org/ehd Program 9�jPo- Element: 4103 PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME 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)—The sterilization certificate provided for the Bowler blades with lot #BE04012019 did not match the lot number on the certificate. Provide a sterilization certificate to the EHD for the Bowler blades with the above lot#. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307.—A current Bloodborne Pathogen Training Certificate was not available for practitioner, Gayle Witt. Provide EHD with a current certificate for Gayle. 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—The medical questionnaire and consent form did not include all information listed on Form B. Update the forms and provide a copy to the EHD. Include the following on the consent form: -Statement regarding permanent nature of procedure. - Notice that inks are not FDA approved and health consequences are unknown. Include the following on the medical questionnaire: - History of herpes infection at the procedure site. - History of allergic reactions to latex. - History of allergic reactions to antibiotics. - History of hemophilia or other bleeding disorders. - History of cardiac valve disease. - Requirements for antibiotics prior to surgery or dental procedures. -Other risk factors for blood borne pathogens. 24. Disinfectant shall have ability to reduce or eliminate the presence of disease-causing microorganisms, including HIV and hepatitis B virus. HSC 119301(k)—Seventh Generation and Clorox wipes are used for disinfecting surfaces.The disinfectants do not have the ability to reduce or eliminate the presence of HIV and Hep. B Virus. Replace disinfectants with another disinfectant that is able to reduce or eliminate the presence of HIV and Hep. B virus. 31. A body art facility shall be separated from any residential areas used for sleeping, bathing, or meal preparation and shall not share a common entrance or toilet facility with residence. The toilet facility must have a sink w th hot and cold water, containerized liquid soap, and single-use paper towels that are dispensed from a wall-mounted, touchless dispenser. HSC 119314—The restroom did not have a wall mounted touchless paper towel dispenser. Install a wall mounted touchless paper towel dispenser in the restroom and provide photographic evidence to the EHD. 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313—The IPCP was not available for review. Submit a copy of the IPCP to the EHD for review. Reinspection on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 EH-11/17