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Body Art Inspection Report <br /> y pecon p Date: March 27,2025 <br /> ?` San Joaquin County Environmental Health Department <br /> Pro gram <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0545320 <br /> (209)468-3420� Program www.s600v.org/ehd g <br /> Element: 4120 <br /> R Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0545463 Michelle Tabancura BBP Exp:2/28/26 <br /> Observations and Corrective Actions: <br /> 9. No food, drink, tobacco product, or personal effects are permitted in the procedure area. The practitioner shall not <br /> eat, drink, or smoke while performing a procedure. If a client requests to eat, drink, or smoke, the procedure shall be <br /> stopped and the procedure site shall be protected from possible contamination while the client leaves the procedure <br /> area to eat, drink, or smoke. HSC 119309(i) <br /> OBSERVATIONS: <br /> 1. Water bottle observed in a basket, in the procedure room. —CORRECTED <br /> 18. Prior to the performance of body art, the client shall read, complete, and sign an informed consent form. HSC <br /> 119303(a). <br /> OBSERVATIONS: <br /> 1. Client consent forms were not completed in full. Some client consent forms were observed to not have all of the medical <br /> questionnaire questions answered. <br /> CORRECTIVE ACTIONS: <br /> 1. Please assure that all of the information on the client consent forms are being completed in full prior to performing the <br /> procedure. <br /> 33. A body art facility shall have all counter surfaces and tray with a smooth, durable, and nonabsorbent finish. <br /> HSC(119314)(b)(6) <br /> OBSERVATIONS: <br /> 1. Observed a plastic wrapped pillow. Pillow made of absorbable material. Plastic not durable enough for repeated use. <br /> 2. Foot stool made of absorbable material was under the procedure bed. —CORRECTED <br /> 3. Bench with pillows (both absorbable) observed in the procedure room. <br /> 4. Plant in the corner of the room can not be easily cleaned when needed. <br /> CORRECTIVE ACTIONS <br /> 1. Remove all of the objects (mentioned above)from the procedure room. <br /> 35. A body art facility shall have a written Infection Prevention Control Plan, and have records of training and shall be <br /> maintained for three years and shall be available for inspection upon request of the enforcement officer HSC 119313(e). <br /> Infection Prevention Control Plan shall be revised when changes are made in the infection prevention practices, <br /> procedures, or tasks HSC 119313(c). <br /> OBSERVATIONS: <br /> 1. IPCP has the listed disinfectant as CaviSpray. Observed onsite disinfectant is CaviWipes. <br /> Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 2 of 3 <br /> EH-12-4-23 <br />