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�ouiry ��°�' °�� Body Art Inspection Report Date: March 8, 2022 /�� "�� j�12: San Joaquin County Environmental Health Department program 1868 E. Hazelton Ave., Stockton, CA 95205 �'� � (296)466-3420 Record: PR0542019 � �"� Program \6�=;c,� ;n„ 'P wwwsioay.oro/ehd /�� 'o_H?� Element: 4120 PR Number PRACTITIONER/ARTIST NAME PR0547498 Am Aca a (BBP exp. 1/21/23) herpes infection at the procedure site. -History of allergic reactions to latex. PR Number PRACTITIONER/ARTIST NAME PR0543522 Carmela Chavez (BBP exp 11/20/20) herpes infection at the procedure site. -History of allergic reactions to latex. Observations and Corrective Actions: 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 Carmela Chavez. The last BBP Certificate on file with the EHD expired on November 20, 2020. Provide a current BBP Certificate to the EHD. 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 client consent form and medical questionnaire did not include all the information listed on Form B, Include the following information and provide a copy to the EHD: Consent form - Description of the procedure. - Description of what the client should expect following the procedure. - Notice that inks are not FDA approved and health consequences are unknown. Medical Questionnaire -History of herpes infection at the procedure site. -History of allergic reactions to latex. -History of allergic reactions to antibiotics. -History of cardiac valve disease. 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 client records were missing the client's photo ID and the lot number of the needles that were used. Ensure client's photo ID is available for review by the EHD and the lot numbers of needles are written on the client record or the package is attached to the client record. 19. At the completion of the procedure, the practitioner shall provide post procedure instructions that include all elements listed in Form B. HSC 119308(b) —The aftercare instructions did not include all elements listed in Form B. Include the following on the aftercare instructions and provide an updated copy to the EHD: -Signs and symptoms of infection. -Indications when to seek medical care. 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 incomplete. Complete the IPCP and provide a copy to the EHD. 37. A body art facility shall not conduct business without a valid health permit. A person shall not perform body art without a valid registration and a permitted facility. A body art facility shall notify the LEA in writing within 30 days of resignation, termination of a practitioner. A new hire or apprentice must be registered the EHD prior to performing body art at the facility. HSC 119312 & 119306 —Practitioner, Carmela Chavez, has not paid past due fees and does not have a current practitioner's permit. Ms. Chavez cannot practice body art without a valid permit. Ms. Chavez is to pay past due balance and is to inform EHD if she intends to practice body art. Correct all violations and provide evidence of corrections to the EHD by March 23, 2022. Reinspection on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 3 EH -11/17