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Body Art Inspectial Report <br /> i San Joaquin County nvironmental Health Department Program <br /> I <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> ' (209)468-3420 Program <br /> gt•;FaRiS`P• www.sElement: <br /> iogv.org/ehd I I -C) <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0541626 Heidi Johnson-BBP and Permit Current and 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 evidence of sterilization for the blade(Gamma Ray, Lot <br /> Number:867542). <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—Include the blade lot number with the clients' records. <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. <br /> Note: <br /> 1. Review the IPCP at least once a year. <br /> Unless otherwise noted, correct all violations prior to April 17, 2019. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />