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Body Art Inspeco Report Date: D <br /> a¢ San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> - Record: <br /> (209) 20 W26c9<iF'ola,P www.siogv.oiogv.org/ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO541683 Jennifer S adafore,BBP AT 6/19/2020 <br /> PRO545109 Crystal Aguirre,BBP CM 2/5/2021 <br /> Observations and Corrective Actions: <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 <br /> Ms.Aguirre's medical questionnaire requires updating to ask whether: <br /> 1: History of herpes infection at the procedure site <br /> 2. Hemophilia or other bleeding disorders <br /> 3. Requirement for antibiotics prior to surgery or dental procedure <br /> Submit a revised copy of the medical questionnaire to the EHD by 3/2412020. <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 <br /> Three client records were reviewed. Ms. Spadafore stated that the records are stored at home. Maintain records <br /> for three years,and make them available to inspectors during the inspection. <br /> Evidence of correction is due to the department by 3/24/2020. <br /> Evidence of correction can be submitted to the department at: eascer(dsjgov.org <br /> Notes: <br /> 1. Sterilization certificates were available for two boxes of Perpetual needles in use in the facility. <br /> 2. The facility has two practitioners. <br /> 3. The handwash sink was supplied with hot water, soap, and a stocked touchless paper towel dispenser. <br /> 4. The Infection Prevention and Control Plan was available for review. The plan references Barbicide and Cavi <br /> wipes. The wet contact time for Barbicide was in the plan. The wet contact time for Cavi wipes was added during <br /> the inspection. The facility only uses Cavi wipes at this time. <br /> 5. Practitioners use separate forms. Driver's license photos are stored on a computer separately from the forms. <br /> 6. A receipt was available for a sharps pick-up by Sharps Solutions on 10/23/2019. <br /> 7. A photo of Ms. Spadafore's bloodborne pathogens training certificate and a Hepatitis B declination certificate were <br /> obtained during the inspection. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 �"1 <br />