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COMPLIANCE INFO_ROMALDO RODRIGUEZ
Environmental Health - Public
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4100 – Safe Body Art
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PR0542669
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COMPLIANCE INFO_ROMALDO RODRIGUEZ
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Last modified
7/5/2023 10:01:01 AM
Creation date
3/22/2023 2:24:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0542669
PE
4110
FACILITY_ID
FA0024548
FACILITY_NAME
LODI MICRO CLINIC (RODRIGUEZ, ROMALDO)
STREET_NUMBER
755
Direction
S
STREET_NAME
FAIRMONT
STREET_TYPE
AVE
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
755 S FAIRMONT AVE STE C
P_LOCATION
02
QC Status
Approved
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EHD - Public
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PR Number <br />Body Art Inspecticaeport <br />PRO542669 <br />Romaldo Rodriguez - BBP and Permit Valid and <br />Posted <br />x c <br />Blanca Rodriguez - BBP and Permit Valid and Posted <br />Date: <br />San Joaquin County Environmental Health Department <br />program <br />A 1 <br />Zbb 8 <br />•"r <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />Record: <br />P R �Sy <br />cd�,FO <br />(209) 468-3420 <br />Program <br />u <br />a`P <br />www.siogv.org/ehd <br />Element: <br />`'1O <br />PR Number <br />PRACTITIONERIARTIST NAME <br />PRO542669 <br />Romaldo Rodriguez - BBP and Permit Valid and <br />Posted <br />PRO542035 <br />Blanca Rodriguez - BBP and Permit Valid and Posted <br />Observations and Corrective Actions: <br />PR Number <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 evidence of sterilization for the needles use by Romaldo. <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) —Sharp waste containers shall be <br />disposed of by a licensed waste hauler or approved mail back system. If planning to utilize the mail back system, <br />provide a written agreement or contract with the company to the EHD. <br />16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br />performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302 — Maintain a copy of the <br />client ID on file with the client consent form. <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) — Blanca's post-procedure instructions are missing the following requirements: "signs and <br />symptoms of infection and indications when to seek medical care." <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 — Maintain a copy of the <br />IPCP in the facility at all time. <br />Note: <br />1. If you have any question, please contact me at (209) 468-3284 or mvue s'cehd.com <br />2. Send a copy of the written agreement or contract with a licensed waste hauler or mail -back system to the EHD. <br />3. Keep record of purchase for the needles and blades in the facility. <br />4. Keep evidence of sterilization for the blades and needles in the facility. <br />5. Provide a copy of the sterilization certificate to the EHD. <br />Correct all violations prior to February 22, 2019. <br />Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br />EH -11/17 §1 <br />
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