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Body Art Inspection Report <br />San Joaquin County Environmental Health Department <br />7868 E. Hazelton Ave., Stockton, CA 95205 <br />(209)468-3420 <br />•�� w _t.F- , �� vrmv sioav ora/ehtl <br />PR Number <br />PRACTITIONERIARTIST NAME <br />PR0544524 <br />Jessie Witt BBP ex .1013/21 <br />PR0537653 <br />Jesse Quezada <br />PR0539819 <br />Mark Escalante BBP ex .9/17/21 <br />PR0544783 <br />Nicholas Tofanelli BBP ex .9121/21 <br />Observations and Corrective Actions: <br />Date: <br />Program <br />Record: <br />Program <br />Element: <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0537482 <br />Dennis Escalante BBP <br />ex .4/8/22 <br />PR0538823 <br />Erick Jimenez BBP ex <br />.1017/21. <br />PR0541001 <br />John Herrera BBP ex <br />.6/26/21 <br />PR0546438 <br />S enter Thomas (BBP <br />ex . 12/9/2T <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) — A sterilization certificate was not available for the Metal Mafia needles <br />used by Mark Escalante with lot #2012 01 and the Cheyenne needles used by Erick Jimenez with lot # 2020-51-049. <br />Provide EHD with sterilization certificates for the needles stated above. <br />7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol <br />and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br />Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) — A manifest for sharps waste disposal <br />was not available during. the inspection. Provide a copy of the manifest of the last sharps waste pick up to the EHD. <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) —Evidence of current Hepatitis B vaccination, <br />immunity or declination form is not on file at the EHD for Jesse Quezada. Provide a copy of immunization record or <br />declination form to the EHD. <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 (BBP) was not available for Jesse Quezada. Provide <br />EHD with a current BBP Certificate. <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 —The client records were incomplete. The name of the artist and the instrument <br />information (name/ item #and lotl batch #) were not provided on the client records. Ensure all client records are <br />complete. <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 —The procedure table in Mark's room had a tear. Repair or replace the <br />procedure table in Mark's room. <br />35. Operation and employee training records shall be maintained for 3 years and made available for inspection. Awritten <br />Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313 —The employee training <br />records were not available for review. Ensure all employees sign the training record, provide a copy to the EHD. <br />Unless otherwise noted provide all corrections to the EHD by April 22, 2021. <br />Reinspecion <br />EH -11/17 <br />A reinspection fee of $152 per hour may be charged. <br />Page 2 of 3 <br />