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Body Art In <br /> spec Report Date: iolg!)Q <br /> San Joaquin County Environmental Health Department Program <br /> , 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 5V-008W93 <br /> (209)468-3420 <br /> Program " <br /> p�.(FgRa www_siogv-oa "/ehd Element: 1 103 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Sharon Krogh <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)—No sterilization certificate on site. Provide EHD with sterilization <br /> certificate and blade lot number. <br /> 12. Practitioner shall provide evidence of current hepatitis B vaccination or hepatitis B immunity or comply with current federal <br /> OSHA hepatitis B vaccination declination requirements. HSC 119306(c)—Proof of Hepatitis B vaccination not available. <br /> Provide Hepatitis B vaccination record, proof of immunity or a Hepatitis B declination form 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—Medical questionnaire should include: <br /> a. History of herpes infection at the procedure site <br /> b. History of allergic reactions to antibiotic <br /> c. History of allergic reaction to latex <br /> d. History of hemophilia or other bleeding disorders <br /> e. Requirements for antibiotics prior to surgery or dental procedures <br /> f. Other risk factors for blood borne pathogens <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)—Include on the aftercare instruction "when to seek medical care." <br /> 33. All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good <br /> repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, <br /> durable, and nonabsorbent finish. HSC 119314—Torn chair and absorbent chair in permanent cosmetic area. Repair torn <br /> chair or remove chair from the area. Move ndii^absorbent chair 5 feet from area or remove from the room. <br /> Notes: <br /> 1. Keep a copy of the clients identification with consent form. <br /> 2. Provide a copy of the Infection Prevention Control Plan to EHD. <br /> All of the above mentioned observations must be corrected, a final consultation must be <br /> conducted, and all applicable fees must be paid prior to opening. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />