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PqutN. ,o.• cod Body Art Inspection Report Date: July 14, 2023 San Joaquin County Environmental Health Department y. 1868 E. Hazelton Ave., Stockton, CA 95205 Record: SR0086933 (209) 468-3420 �t/ www.siogv.org/ehd Program `SLEo - Element: 4103 PR Number PRACTITIONER/ARTIST NAME Leticia Harris (BBP Exp. 3/2/24 Observations and Corrective Actions: I PR Number I PRACTITIONER/ARTIST NAME I I I Britteni Chandler (BBP Exo 8/23/23) 1 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) —A sterilization certificate and invoice were not available for the Mast needle cartridges with the lot #2022-07-01. Provide EHD with a sterilization certificate and an invoice for the needle cartridge mentioned. 8. Jewelry placed in newly pierced skin shall be sterilized prior to piercing or purchased presterilized. If purchased presterilized, sterile packs shall be discarded if integrity is compromised. Clean calipers shall be used and the skin marked using clean toothpicks and ink or a single -use marking pen. Sterilized instruments shall be stored in sterilization packaging or in sterilization equipment cartridge until time of use. Sterile instrument packs shall be evaluated before use and shall be discarded if integrity is compromised. HSC 119310 —The marking pen was not single use. Replace the marking pen with a single use item. 18. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HSC 119303 —The client consent form and medical questionnaire did not include all of the information from Form B. Include the following and provide a copy to the EHD: Consent Form - Description of procedure. - Notice that inks are not FDA approved and health consequences are unknown. Medical Questionnaire - History of herpes infection at the procedure site. - History of allergic reactions to latex. - History of allergic reactions to antibiotics. - History of hemophilia or other bleeding disorders. - History of cardiac valve disease. - Current medications. - Other risk factors for bloodborne pathogens. Correct all observations and provide evidence of corrections to the EHD by July 28, 2023. Reinspection on/about: A reinspection fee of $162 per hour may be charged. Page 2 of 3 EH -11/17