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Body Art InspectioTi Report <br /> ' c Date: a/I Z420 <br /> y h San Joaquin County Environmental Health Department Program <br /> � 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> c i (209)4683420 Program <br /> a<iFgFa'� www.Slogv.orq/ehd g <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO544051 H nek Washington <br /> PR0537587 Jose Diaz(BBP exp. 1/17/20 <br /> PR0545322 Andraya Har <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)—The record of purchase and sterilization certificate were not available for <br /> Big Wasp needle lot#08/2019. Provide the EHD with a record of purchase and sterilization certificate for the instruments <br /> used. <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307.—A current Bloodborne Pathogen Training certificate was not available for Andraya or Hynek.Submit a <br /> current Bloodborne Pathogen Training Certificate to the 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—A client consent form and medical questionnaire did not include all the information <br /> listed in Form B. Ensure all the information from Form B is included on the client consent form and medical <br /> questionnaire.Submit a copy to the EHD. <br /> 32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. The <br /> body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to floor, <br /> from nail and hair activities and be separated from all business not related to body art. Approval of co-located body art facilities <br /> are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br /> procedure area shall have lined waste containers. HSC 119314& 119317—The floor. Is in need of repair. Repair the floor in <br /> the procedure room and submit photographic evidence to the EHD. <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—An Infection <br /> Prevention Control Plan and training records were not available. Provide a completed copy of the Infection Prevention <br /> Control Plan and evidence of training to the EHD. <br /> Correct all violations by March 10, 2020. A reinspection fee of $152/hr. will be <br /> charged. <br /> Notes: <br /> 1. Post the Bloodborne Pathogen Training Certificate in a conspicuous place, once it's received. <br /> 2.Jose Diaz has moved out of state, his body art practitioner's permit will remain active but a current Bloodborne <br /> Pathogen Training Certificate is needed. <br /> 3.Andraya will email the Infection Prevention and Control Plan and the Bloodborne Pathogen Training Certificates. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />