(a) The specialty hospital shall provide or ensure provision of a planned combination of medical treatment and active programming through the use of preventive, habilitative and rehabilitation programs (see section 680.13). These programs shall be divided into the following categories:

1. (1) Mandatory (see section 680.13). Those services which are required for every individual on a daily basis.
2. (2) Selective (see section 680.13). Those services which are available at all times in the specialty hospital, and required for some individuals in the manner and frequency prescribed by the person's individual program plan.
3. (3) Combination. Those mandatory and selective services which are combined to provide preventive, habilitative and rehabilitative programs in medical treatment and active programming in a concerted effort to reduce the health care problems which necessitated the individual's admission to the specialty hospital.

(b) Mandatory services (see section 680.13 under specific disciplines) include:

1. (1) medical services;
2. (2) nursing services;
3. (3) nutrition services;
4. (4) recreation services; and

5. (5) self-care services. They shall be provided to each individual every day in accordance with an individual's individual program plan and conform with the following requirements:

   1. (i) Medical services.

      1. (a) The medical director shall ensure that the medical staff carries out the following responsibilities relating to services, as appropriate:

         1. (1) providing and supervising medical treatment through the delivery of preventive, habilitative and rehabilitative programs;
         2. (2) providing health care consultation and referral of individuals to appropriate health care specialists;
         3. (3) developing and amending medical policies and procedures for matters such as physician visits, emergency coverage, records, consultations and participation in the interdisciplinary team processes and services;
         4. (4) advising the specialty hospital administrator regarding medical and related problems;
         5. (5) establishing necessary professional relationships with other institutions and agencies such as general or special hospitals, medical schools, rehabilitation centers, nursing homes, health-related facilities, home health agencies, hospital outpatient departments, diagnostic and treatment facilities, clinics, laboratories and related resources;
         6. (6) detection and treatment of health problems, through adequate medical surveillance, periodic inspection and regular medical examination.

         7. (7) semi-annual physical examinations that include:

            1. (i) examination of vision and hearing;
            2. (ii) routine laboratory examinations, as deemed necessary by the physician; and special studies when the index of suspicion is high; and
            3. (iii) assessment of the need for a comprehensive physical therapy evaluation and services for all individuals including and especially those who are nonambulatory, have cerebral palsy, have undergone orthopedic surgery or who have other orthopedic problems.
         8. (8) immunization, using as a guide the recommendations of the United States Public Health Service Advisory Committee on Immunization Practices and/or the Committee on the Control of Infectious Diseases of the American Academy on Pediatrics as appropriate to the specialty hospital's population;
         9. (9) tuberculosis control, in accordance with the recommendations of the American College of Chest Physicians and/or the section on diseases of the chest of the American Academy of Pediatrics, as appropriate to the specialty hospital's population;
         10. (10) reporting of communicable diseases and infections in accordance with law;
         11. (11) genetic counseling to individuals and next of kin; and
         12. (12) reviewing and responding to suggestions of pharmacists and registered nurses for modifications in individual's medications.

      2. (b) There shall be a formal arrangement for qualified medical care for the individual, including care for medical emergencies at all times.

         1. (1) Procedures shall be established that provide steps to be followed when the primary care physician is not available.
         2. (2) The names and telephone numbers of physicians and/or personnel to be called in the event of an emergency shall be posted.
      3. (c) Upon admission of the individual, a medication history of prescription and nonprescription drugs shall be obtained and this information shall be entered in the individual's record.
      4. (d) An individual record shall be maintained for each individual of all medications (prescription and nonprescription) dispensed, including the quantities and frequency of refill.
      5. (e) The medical director shall maintain effective arrangements through which medical services required by the individuals but not regularly provided within the specialty hospital can be obtained promptly when needed.

   2. (ii) Nursing services.

      1. (a) The objectives of nursing services shall be to evaluate each individual's need for nursing care on a continuing basis, and to provide such care directly by or under the supervision of a registered nurse (see section 680.13 of this Part). Such services shall include:

         1. (1) development of a written nursing services plan for each person as part of the individual program plan;
         2. (2) participation in preventive, habilitative and rehabilitative services to eliminate, limit or reduce the individual's health related problem;
         3. (3) review of each individual's nursing services plan in terms of the individual's daily needs, at least quarterly and more frequently for those with an acute or chronic condition requiring treatment and/or surveillance by a physician or other health professional level health care staff;

         4. (4) control of communicable diseases and infections through:

            1. (i) identification and assessment;
            2. (ii) reporting to medical authorities; and
            3. (iii) implementation of appropriate protective and preventive measures.
         5. (5) modification of the nursing services plan as necessary.
      2. (b) Health care staff shall monitor effects of medication and make periodic checks to assure that individuals are taking their medications as prescribed, that prescriptions are renewed as necessary and that outdated or discontinued drugs are returned to the pharmacy or disposed of according to the policies of the appropriate regulatory agency and the facility.
      3. (c) The health care staff shall make periodic checks to ensure that individuals are maintaining an adequate level of personal hygiene.
      4. (d) The health care staff shall secure the services of the individual's physician for illness or injury and for continuing and preventive health services.
      5. (e) The medical director shall ensure that written notations are made in the individual's record regarding significant changes in the individual's program performance, attitudes, feelings and physical condition which may be the result of medical treatment.

   3. (iii) Nutrition services.

      1. (a) The administrator is responsible for providing or ensuring the provision of meals of adequate nutrition including medically prescribed diets of suitable quality and adequate quantity.
      2. (b) Dietary counseling shall be provided as indicated in each individual's service plan.

      3. (c) Nutrition services shall include:

         1. (1) supervision of individuals during meal times to ensure that individuals are receiving nutritionally adequate amounts of food and fluid at proper temperatures;

         2. (2) menu planning:

            1. (i) menus shall be written in advance. Menus shall provide a sufficient variety of foods served in adequate amounts at each meal, and shall be different for each day of the week and adjusted for seasonal change;
            2. (ii) records of menus as served shall be filed and maintained for at least 30 days; and
            3. (iii) menus shall be planned in such a way as to meet the food and nutrition needs of individuals in accordance with the recommended allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences, adjusted for age, sex, activity and disability. The menu shall provide a nourishing, well-balanced diet unless contraindicated by medical needs.
         3. (3) establishing specifications for food purchases and ensuring that such specifications are met. Records of food purchased for preparation shall be filed and maintained for at least 30 days;
         4. (4) initiating food orders or requisitions shall be the responsibility of the dietitian (see section 680.13) or designated supervisor in accordance with established requirements;

         5. (5) storing and handling of food;

            1. (i) Dry or staple food items shall be stored at least 12 inches above the floor, in a ventilated room not subject to sewage or waste water backflow, or contamination by condensation, leakage or vermin.
            2. (ii) Perishable foods shall be stored at the proper temperature to conserve nutritive values.
            3. (iii) Adequate means of safeguarding foods against spoilage shall be developed and implemented.
         6. (6) food preparation. A file of tested recipes, adjusted for appropriate yield, shall be maintained;

         7. (7) food shall be served in conformity with the following:

            1. (i) Each individual shall be given the appropriate quantity of food, at an appropriate temperature, in a form consistent with the developmental level of each individual, and with appropriate utensils.
            2. (ii) Meals shall be served at a time comparable to mealtimes existing in the community, unless medically contraindicated.
            3. (iii) Food served to individuals and not consumed shall be discarded.
            4. (iv) Denial of a nutritionally adequate diet shall not be used as punishment.

         8. (8) maintaining sanitary standards in compliance with State and local regulations. Such standards shall include, but not be limited to:

            1. (i) following effective procedures for cleaning all equipment, work and eating areas;
            2. (ii) providing handwashing faciilties, including hot and cold water, soap and paper towels adjacent to work areas;
            3. (iii) ensuring that food service personnel wear clean clothing. Personnel with long hair shall wear hair nets and personnel with short hair shall wear clean caps;
            4. (iv) ensuring that there are routine health examinations for food service personnel; and
            5. (v) ensuring that personnel having symptoms of communicable diseases or open wounds are not permitted to participate in food preparation or service.
         9. (9) orientation, training and supervision of food service personnel.

      4. (d) All individuals, including those who are mobile nonambulatory, shall eat in dining areas, except when contraindicated for health reasons or by decision of the team responsible for the individual's program. Individuals shall eat in an upright position unless medically contraindicated. Such medical recommendations shall be documented in the individual's program plan. Individuals shall eat in a manner consistent with their developmental needs.

         1. (1) Dining areas shall be equipped with tables, chairs, eating utensils and dishes designed to meet the developmental needs of each individual.
         2. (2) Dining areas shall be adequately supervised and staffed for the direction of self-help dining procedures, and to ensure that each individual receives an adequate amount of food.
         3. (3) Individuals shall be provided with systematic training to develop appropriate eating skills, utilizing appropriate individualized adaptive equipment when it serves the developmental process.

      5. (e) As appropriate, modified diets shall be:

         1. (1) prescribed by the individual's physician with a record of the prescription kept on file;
         2. (2) planned, prepared, and served by persons who have received adequate instruction; and
         3. (3) periodically reviewed and adjusted as needed, but no less frequently than every 30 days. Such reviews are to be documented in the individual's program plan.
      6. (f) Staff shall be trained in and shall utilize proper feeding techniques.
      7. (g) There shall be a sufficient number of trained and designated personnel to fulfill the food and nutrition needs of each individual.

   4. (iv) Recreation services.

      1. (a) Each individual shall be provided with a planned program of meaningful recreation activities every day.
      2. (b) The program shall provide all equipment and supplies necessary for the conduct of the recreation activities.

      3. (c) The specialty hospital administrator shall ensure that:

         1. (1) a program of meaningful activities are planned and conducted, including those which are intellectually stimulating, augment health maintenance, encourage the participation of the individuals in the community, and involve appropriate volunteers and volunteer groups, except for those individuals where there is documentation that such activities would be medically contraindicated;
         2. (2) activities are conducted for each individual during afternoon and evening hours and on weekends and holidays;
         3. (3) a current monthly schedule of activities is posted to provide information to individuals and staff; and
         4. (4) recreation services are coordinated with individualized health care, medical treatment and active programming and are derived from the interdisciplinary team planning process.

   5. (v) Self-care services.

      1. (a) Each individual shall receive individually planned services and activities designed to improve his or her ability to independently perform routine activities of daily living, including, but not limited to, bathing, brushing teeth, shampooing, combing and brushing hair, shaving and caring for toenails and fingernails. Items for these activities shall be issued to each individual and marked in a way that will appropriately identify each individual's items.
      2. (b) A toilet training program shall be provided for each individual who does not have adequate self-toileting skills and does not have a documented medical condition which prevents the acquisition of these skills. Records shall be kept of the progress of each individual receiving toilet training. Individuals who are incontinent shall be immediately bathed or cleaned upon voiding or soiling unless specifically contraindicated by the training program as documented in the individual's program plan.
      3. (c) Training in the activities of daily living shall be provided, and coordinated with the provision of other services to ensure that individuals who are able, develop or improve independent self-care skills.
      4. (d) The specialty hospital administrator shall ensure provision of suitable and adequate space appropriately designed and equipped for the training and practice of activities of daily living.

(c) Selective services (see section 680.13 under specific disciplines) include:

1. (1) communication services;
2. (2) dental services;
3. (3) education services;
4. (4) occupational therapy services;
5. (5) optometric services;
6. (6) orthotic services;
7. (7) pharmacy services;
8. (8) physical therapy services;
9. (9) psychology services;
10. (10) respiratory therapy;
11. (11) social services;
12. (12) special medical services;
13. (13) special diagnostic services; and

14. (14) transportation services. Selective services shall be available at all times to individuals who require them. Because a specialty hospital is designed to provide specialized treatment to individuals whose disability prevents movement to a less restrictive treatment alternative, selective services shall be delivered in such a manner as to effect that movement as soon as possible. Therefore, it may be necessary to concentrate on particular types of services throughout an individual's stay at the specialty hospital while the provision of other kinds of habilitative services which a person needs are postponed until the person has reached the treatment goal of movement to a less restrictive placement. Selective services may be provided by staff of the specialty hospital or through contract with other agencies in conformity with the following requirements.

    1. (i) Communication services.

       1. (a) Communication services shall be rendered:

          1. (1) directly, through contract between speech pathologists, audiologists (see section 680.13 under “Professional Staff”) and individuals; and
          2. (2) indirectly, by working with other service providers in implementing communication improvement programs in the residential and program setting.

       2. (b) Communication services available to individuals in a specialty hospital shall include:

          1. (1) development of receptive and expressive communication skills; and

          2. (2) assessment of hearing loss and receiptive and expressive language disorders, to include:

             1. (i) comprehensive audiological screening, to include tests of pure-tone air and bone conduction, speech audiometry, and other procedures, as necessary, and to include assessment with the use of visual cues;
             2. (ii) assessment with the use of amplification; and
             3. (iii) for individuals who do not speak, assessment of the capability to benefit from instruction in signing, the use of communication boards or other methods to increase receptive and expressive language skills.

          3. (3) comprehensive speech and language remediation of individuals including:

             1. (i) instruction in signing, use of communication boards and other devices to increase receptive and expressive language skills;
             2. (ii) procurement, maintenance and replacement of hearing aids, as specified by a qualified audiologist;
             3. (iii) reading service for individuals who are blind and interpretive services for individuals who are deaf; and
             4. (iv) space, facilities, equipment and supplies adequate for providing efficient and effective communication services.

    2. (ii) Dental services.

       1. (a) Comprehensive dental services shall be provided by the specialty hospital, or through contract, which include the following:

          1. (1) a complete extra and intraoral examination utilizing all diagnostic aids necessary to properly evaluate the individual's oral condition. Such examination shall occur within one month following admission, unless such an examination was done within the six months immediately prior to admission and the results are received and reviewed by the specialty hospital's medical director and are entered in the individual's record;
          2. (2) dental treatment as needed by individuals, including oral surgery, orthodontics, periodontics and prostheses;
          3. (3) provision for emergency treatment on a 24-hour-a-day, 7-day-a-week basis by a qualified dentist (see section 680.13 under “Professional Staff”);
          4. (4) a recall system that will ensure that each individual is reexamined at specific intervals in accordance with his or her needs, but at least annually;

          5. (5) a dental hygiene program that includes:

             1. (i) instruction of individuals and staff in proper oral hygiene methods; and
             2. (ii) instruction of parents or other care givers in the maintenance of proper oral hygiene, where appropriate.
          6. (6) maintaining a permanent dental record for each individual. A summary dental progress report shall be entered in the individual's record at stated intervals; and
          7. (7) all dentists and dental hygienists (see section 680.13 under “Other Staff”) providing services to the specialty hospital shall be fully licensed to practice in New York State.

    3. (iii) Educational services.

       1. (a) Educational services shall be provided for individuals under 21 years of age only when a person's health-related problems and treatment for them prevent an individual from attending educational programs in the community and these services are recommended by the individual's interdisciplinary team. Under these circumstances, educational services shall be provided as directed by the interdisciplinary team in the least restrictive and most normalizing manner.
       2. (b) Educational services shall be available during both afternoon and evening hours and at bedside for those individuals who require such arrangements.

       3. (c) Available educational services shall include:

          1. (1) instruction in self-care skills and activities necessary for self-preservation; and
          2. (2) instruction in pre-academic and communicative and computational skill areas.

    4. (iv) Occupational therapy services.

       1. (a) Occupational therapy services shall be provided directly, through personal contact between occupational therapists (see section 680.13 under “Professional Staff”) and individuals, and indirectly, through contact between therapists and other persons involved with the individual.

       2. (b) Occupational therapy staff shall provide treatment and training programs that are designed to:

          1. (1) preserve and improve abilities for independent functioning, including activities of daily living; and
          2. (2) prevent, insofar as possible, irreducible or progressive disabilities, through means such as the use of orthotic and prosthetic appliances, assistive and adaptive devices, positioning, behavior adaptation and sensory stimulation.
       3. (c) The therapist shall function closely with the individual's primary physician, other health care specialists and program staff.
       4. (d) The therapist shall ensure integration of these services with all other aspects of the individual's program plan.

    5. (v) Optometric services.

       1. (a) Optometric services shall be provided by a licensed ophthalmologist either directly by the specialty hospital or through written contract with another agency.

       2. (b) These services shall include:

          1. (1) assessment of vision and/or visual disability;
          2. (2) provision and repair of glasses, contact lenses and any other visual prosthetic devices needed by the individual;
          3. (3) ophthalmologic treatment as needed by individuals including surgery and/or medication; and
          4. (4) a recall system that will ensure that each individual is reexamined at specific intervals in accordance with his or her needs, but at least annually.

    6. (vi) Orthotic services.

       1. (a) Orthotic services shall be provided either directly by the specialty hospital or through written contract with another agency.

       2. (b) These services shall include:

          1. (1) assessment of each individual's need for 24-hour adaptive equipment;
          2. (2) design, construction, modification and repair of all adaptive equipment needed by individuals; and
          3. (3) design, construction, modification and repair of all adaptive equipment that a individual requires to move from the specialty hospital to a less restrictive setting.

    7. (vii) Pharmacy services.

       1. (a) Pharmacy services shall be provided by an appropriately registered pharmacy (i.e. current registration with the New York State Board of Pharmacy, and the New York State Department of Health, as appropriate) under the direction of a licensed pharmacist (see section 680.13 under “Professional Staff”). These services shall be provided either directly by the specialty hospital or through written contract with another agency. Such services shall include provision for emergency service.
       2. (b) A pharmacist or registered nurse shall regularly review the record of each individual on medication for potential adverse reactions, allergies, interactions, contraindications, rationality and laboratory test modifications, and advise the physician of any recommended changes, with reasons and with an alternative drug regimen.
       3. (c) Each drug shall be identified up to the point of administration. Medications shall not be used for any person other than the one for whom they were prescribed.

       4. (d) Drugs that are stored on the premises shall be stored under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation and security.

          1. (1) All drugs shall be kept under lock and key, unless authorized personnel are in attendance.
          2. (2) The security requirements of Federal and State laws shall be satisfied in storerooms and pharmacies.
          3. (3) Poisons, drugs used externally and drugs taken internally shall be stored on separate shelves or in separate cabinets at all locations.
          4. (4) Medications that are stored in a refrigerator containing things other than drugs shall be kept in a separate locked compartment.
          5. (5) If there is a drug storeroom separate from the pharmacy, there shall be a perpetual inventory of receipts and issues of all drugs from such storeroom.
       5. (e) There shall be automatic stop orders on all drugs.
       6. (f) There shall be an emergency kit available to each living unit and program site and constituted so as to be appropriate to the needs of the individuals. The approved stock of antidotes and other emergency drugs shall be maintained in the pharmacy and in personal care areas.
       7. (g) Authoritative and recent antidote information, as well as the phone number of the regional poison control center, should be prominently displayed in the area where drugs are stored.

       8. (h) If pharmacy services are provided directly by the specialty hospital, there shall be:

          1. (1) a current pharmacy manual that includes policies and procedures and defines the functions and responsibilities relating to pharmacy services. This manual shall be developed by the responsible pharmacist, physician, nurse and other professional staff, as appropriate to the specialty hospital. The pharmacy manual shall be revised as often as necessary, but at least annually, to keep abreast of current developments in services and management techniques. This manual shall include, but not be limited to, policies and procedures governing:

             1. (i) filling prescriptions and maintaining drug supplies. The substitution of generic drugs for brand name drugs shall be mandatory unless the prescription specifically states that the brand name drug prescribed must be used;
             2. (ii) maximum intervals allowed for prescriptions of antibiotics; anticoagulants; anti-inflammatory agents with a high liability for causing serious adverse reactions; Schedule II, III, IV and V Controlled Substances prescribed for stated administration intervals; Schedule II, III, IV and V Controlled Substances prescribed for p.r.n. administration; steroids and hormones; sulfonamides; and other medications. Such maximum intervals shall reflect New York State Department of Health regulations;
             3. (iii) a drug recall procedure that can be readily implemented and includes provision for returning the following to the pharmacy for proper disposition: all discontinued and outdated drugs and containers with illegible or missing labels;
             4. (iv) disposal of excess, contaminated, and partial doses of parenteral controlled substances. Such disposal procedures shall be in accordance with the New York State Public Health Laws, and the Comprehensive Drug Abuse and Prevention Act of 1970; and
             5. (v) control of syringes and needles.
          2. (2) a formulary system approved by the medical director and pharmacist, and by other appropriate specialty hospital staff. Copies of the program's formulary and of the American Hospital Formulary Service shall be located and available, as appropriate, at the specialty hospital;
          3. (3) quality specifications established by the pharmacist for drugs purchased. The pharmacy shall ensure that these specifications are met. The compounding, packaging, labeling and dispensing of drugs shall be done by the pharmacist or under his supervision, with proper controls and records. Samples and investigational drugs shall not be used. Whenever possible, drugs that require dosage measurement shall be dispensed by the pharmacist in a form ready to be administered to the individual.

    8. (viii) Physical therapy services.

       1. (a) Physical therapy services shall be provided directly, through personal contact between physical therapists (see section 680.13) and individuals, and indirectly, through contact between therapists and other persons involved with the individual.

       2. (b) Physical therapy staff shall provide treatment and training programs that are designed to:

          1. (1) preserve and improve abilities for independent functioning, such as range of motion, strength, tolerance and coordination; and
          2. (2) prevent, insofar as possible, irreducible or progressive disabilities, through means such as the use of orthotic and prosthetic appliances, assistive and adaptive devices, positioning, behavior adaptation and sensory stimulation.
       3. (c) The therapist shall function closely with the individual's primary phycician, other health care specialists and program staff.
       4. (d) The therapist shall ensure integration of these services with all other aspects of the individual's program plan.

    9. (ix) Psychology services.

       1. (a) Psychology services shall be rendered:

          1. (1) directly, through contact between psychologists (see section 680.13 under “Professional Staff”) and individuals; and
          2. (2) indirectly, through contact between psychologists, other staff members providing services to the individuals and their families.
       2. (b) Psychologists shall participate, when appropriate, in the continuing interdisciplinary assessment of individuals for the purposes of planning, implementation and monitoring of individual program plans.
       3. (c) Psychologists shall participate in staff training, program development and program evaluation.
       4. (d) Psychologists shall design and participate in therapies which assist individuals with orientation and adjustment to their disabilities, as well as providing compensatory mechanisms for their disabilities.

    10. (x) Respiratory services.

        1. (a) Respiratory therapy services shall be available to individuals in need of such aid and shall include, but not be limited to:

           1. (1) routine treatment of chronic lung disorders, including appropriate inhalation therapy;
           2. (2) physical respiratory therapy, such as postural drainage; and
           3. (3) mechanical ventilation.
        2. (b) Respiratory therapy services shall be delivered according to the prescription of the physician.
        3. (c) The respiratory therapist shall function closely with the individual's primary physician, other health care specialists and program staff.
        4. (d) Space, equipment and supplies shall be adequate to provide efficient and effective respiratory therapy.

    11. (xi) Social services.

        1. (a) Social services shall be provided directly by or under the supervision of certified social workers (see section 680.13 under “Professional Staff”).
        2. (b) Social workers shall arrange for the use of other community resources, coordinate and provide liaison between the individual and community resources, including the day program, services of generic hospitals (see section 680.13), and other generic health care settings (see section 680.13), nursing homes, home health agencies, community social agencies and other service resources.

        3. (c) Social services, as part of an interdisciplinary spectrum of services, shall be provided to the individuals through the use of social work methods directed toward:

           1. (1) facilitating the movement of each individual to a less restrictive alternative placement within the time frames specified prior to admission;
           2. (2) maximizing the social functioning of each individual;
           3. (3) enhancing the coping capacity of staff providing services and programs to the individual;
           4. (4) enhancing the coping capacity of the individual's family; and
           5. (5) asserting and safeguarding the human and civil rights of people with developmental disabilities and their families and fostering the human dignity and personal worth of each person.
        4. (d) Social workers shall participate, when appropriate, in the continuing interdisciplinary evaluation of individual individuals for the purposes of implementation, monitoring and follow-up of individual program plans.

    12. (xii) Special medical services. The medical director shall arrange for special medical services ordered by authorized practitioners for individuals, by promptly:

        1. (a) ensuring that such services as the specialty hospital is able to provide directly are performed; and
        2. (b) sending individuals to an approved agency for services that the facility does not provide.

    13. (xiii) Special diagnostic services. The medical director shall arrange for special diagnostic services ordered by authorized practitioners for individuals, by promptly:

        1. (a) ensuring that such services as the specialty hospital is able to provide directly are performed; and
        2. (b) sending individuals to an approved agency for services that the facility does not provide.

    14. (xiv) Transportation services.

        1. (a) The specialty hospital shall ensure the provision of appropriate transportation of individuals to and from all other sites of programs, services and activities. The facility shall provide transportation if no other form of appropriate transportation is available.
        2. (b) Vehicles used shall be appropriate to the age and condition of individuals so as to ensure their comfort and safety.