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Body Art Inspect Report • Date: b l <br /> San Joaquin County Environmental Health Department Program f ' / <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PKO� H y D 2 I <br /> •` (209)468-3420 <br /> cd<�F6aa`P www,siogv.org/ehd Program Ll <br /> 12-0 <br /> Element: � <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0539789 Gerardo Rivera:Current and Posted Leslie Terrones:Current and Posted <br /> PR0543740 Yecenia Rosas:Expired and Posted <br /> PRO543495 Alexis Castillo-Rocha:Current and Posted <br /> PRO544557 Gabriel Flores Alcauter: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 copies of the sterilization certificates and invoices for all <br /> practitioners working at the facility. <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b)- <br /> Repair the right hand-wash sink in order to supply hot and cold running water to all practitioners. <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307.-Provide a current bloodborne pathogen training certificate for Yecenia Rosas.Submit a copy to the <br /> EHD. <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-On the client consent form include a copy of the client identification card and <br /> ensure that the clients complete the form entirely. Include the lot number and expiration date on the consent form. <br /> Medical Questionnaire: <br /> Include"other bleeding disorders"to the hemophilia phrase. <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)-Provide more details regarding how the client should care for the procedure site. Provide <br /> updated form to the EHD. <br /> 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312-Post all <br /> health permit in a conspicuous place. <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-Review the IPCP with <br /> all new practitioners once they start working at the facility. Ensure they sign and date the IPCP. Review the IPCP with all <br /> practitioners annually and have them sign and date the IPCP. <br /> Notes: <br /> 1. One sink to every two practitioners. <br /> 2. Alexis Castillo-Rocha is planning to work at the facility. She only does piercing. <br /> Reinspecion onlabout: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />