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Body Art Inspecti&eport Date: 1 /1019 <br /> °i San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: MO311L� <br /> 11 <br /> (209)468-3420 Program <br /> 41!0- Element: <br /> www.sioov.org/ehd H I LO <br /> -�' <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Lieu Thi Nguyen-Permit and BBP updated and <br /> PR0537098 posted <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 proof of sterilization for the blades use for the procedure.Obtain <br /> proof of sterilization on Tina Davies's website. Contact OPM organic permanent makeup to obtain sterilization record. <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 <br /> system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e)—Provide a written agreement or <br /> contract with an approved mail back system if planning to utilize the mail back system. <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—Medical questionnaire is missing the following information: history of herpes <br /> infection at the procedure site, history of allergic reactions to latex, history of allergic reactions to antibiotics, history of <br /> hemophilia or other bleeding disorders,history of cardiac valve disease, requirements for antibiotics prior to surgery or <br /> dental procedure. Provide these information on the medical questionnaire. <br /> On the client consent form include a statement about"notice that inks are not FDA approved and health consequences <br /> are unknown." <br /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b)—On the postprocedure instructions provide a statement regarding when to seek medical care. <br /> 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, <br /> marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC <br /> 119311(a)—All products applied to the skin should be single use.The eyebrow pencil is not single use. Continue using <br /> single use applicator instead of the eyebrow pencil.Violation corrected on site. <br /> Jb. Uperatlon 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—IPCP was not on site. <br /> Always have IPCP on site. Update IPCP every year and update the information on the waste hauler section. <br /> Notes: <br /> 1) Send all corrected violations to mvue(a-),slcehd.com <br /> 2) Provide copy of updated IPCP <br /> 3) Provide evidence of sterilization <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />