Filed 9/4/15 In re Nathaniel L. CA4/1 NOT TO BE PUBLISHED IN OFFICIAL REPORTS
California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). Thi s opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

COURT OF APPEAL, FOUR T H APPELLATE DISTRICT

DIVISION ONE STATE OF CALIFORNIA

In re N ATHANIEL L ., a Person Coming Under the Juvenile Court Law.
SAN DIEGO COUNTY HEALTH AND HUMAN SERVICES AGENCY, Plaintiff and Respondent,

v. CANDY L. , Defendant and Appellant ; JESUS L., Appellant. D067280
(Super. Ct. No. S J11241D )

APPEAL S from an order of the Superior Court of San Diego County, Laura J. Birkmeyer , Judge. Affirmed.

Monica Vogelmann, under appointment by the Court of Appeal, for Defendant and Appellant Candy L.2

Neale B. Gold, under appointment by the Court of Appeal, for Appellant Jesus L., a Minor. Thomas E. Montgomery, County Cou nsel, John E. Philips, Chief Deputy County Counsel, and Jennifer Stone, Deputy County Counsel, for Plaintiff and Respondent. Minor Jesus L. and his mother Candy L

. separately appeal an order under Welfare
and Institutions Code section 366.26 1 selecting ad option as the permanent plan for Candy ' s son and Jesus ' s sibling Nathaniel L. , and terminating parental rights. Candy contends the court erred in finding that there was not a beneficial parent

- child relationship between her and Nathaniel within the meanin g of section 366.26, subdivision (c)(1)(B)(i) that precluded the termination of her parental rights. Both Candy and Jesus contend that the court erred in finding the sibling relationship exception to termination of parental rights and adoption under secti on 366.26, subdivision (c)(1)(B)(v) did not apply. We affirm.
Overview
T he Agency detained Nathaniel and his three older siblings in April 2012 and the juvenile court assumed jurisdiction over them in June 2012. In November 2012 , Candy gave birth to her fifth child , who was not removed from her custody or made a dependent of the court. Nathaniel was placed in foster care separately from his siblings. In mid

2013 , Nathaniel was diagnosed with a chronic, life

- threatening kidney condition

. At the
18

- mont h review hearing, the court returned Nathaniel ' s three older siblings to Candy ' s

1 All statutory references are to the Welfare and Institutions Code unless otherwise specified.3

custody but continued Nathaniel ' s foster placement largely due to his medical condition

. After his condition was diagnosed, Nathaniel ' s medical fragility and special healthca re needs became the main focus of his dependency case and the decision to terminate parental rights as to him

.

FACTUAL AND PROCEDURAL BACKGROUND In April 2012 , the San Diego County Health and Human Services Agency (the Agency) detained and filed petition s on behalf of then one - year - old N athaniel and his three older half siblings, eight

- year - old Nevaeh, seven

- year - old Mia, and five

- year - old
Jesus. Nathaniel ' s petition alleged under section 300, subdivision (j) that there was a substantial risk Nathaniel w ould be abused or neglected because Mia and Jesus had been sexually abused by a member of the household . In a second count, the petition alleged that Nathaniel ' s father , Daniel G. , had hit Nathaniel ' s sibling with a closed fist on multiple occasions

. In forensic interviews Mia and Jesus disclosed that their maternal uncle who resided in their home had repeatedly engaged in sexual acts with them, including forcing both of them to orally copulate him. The maternal uncle confessed to police detectives that he had forced Mia and Jesus to orally copulate him and had raped Mia. He also told the detectives that he might have sodomized Jesus but did not remember. Nevaeh, Mia, and Jesus told Agency and forensic interviewers that Daniel had punched them in the

c hest or mouth when they were in trouble. Mia said she had been hit with a hanger and belt and had seen Candy hit Jesus in the mouth , which caused bleeding

. Jesus said that Candy and Daniel hit him on the butt and that his lip bled when Daniel punched it

.4

Nevaeh, Mia, and Jesus were detained in a confidential foster home and Nathaniel was detained in his pa ternal uncle ' s home. The court ordered liberal supervised visitation for Nathaniel ' s parents. The Agency ' s jurisdiction/disposition report filed on May 11, 2012 , noted that Candy was pregnant with her fifth child and was living with the maternal grandmother. She was no longer in a relationship with Daniel due to domestic violence. She denied having any contact with the maternal uncle who sexually ab used the children and did not want to have any contact with him in the future. She had used marijuana and methamphetamine in the past and completed a drug treatment program in 2009. Candy was attending three supervised visits with the children per week and the visits had gone well. The Agency searched for a placement that would accommodate all four children, but Nathaniel remained placed with his paternal uncle while the other three children were placed together in a foster hom e . At the jurisdiction/d isposition hearing on June 14, 2012, Candy admitted the allegations in Nathaniel ' s petition and the court sustained the petition and made true findings on both counts. The court removed Nathaniel from parental custody and ordered him placed in the approve d home of a relative (the paternal uncle). The court gave the social worker discretion to lift supervised visitation and expand to overnight visits or a
60

- day trial visit with the concurrence of Nathaniel ' s counsel. The court also ordered sibling visita tion. In August 2012, the Agency rescinded its approval of the paternal uncle as a placement for Nathaniel and detained Nathaniel in a licensed foster home after it5

discovered that the paternal uncle regularly used medical marijuana. T he Agency filed a section 387 petition alleging that Nathaniel ' s paternal uncle was no longer able to provide adequate care and supervision for Nathaniel and re commending that Nathaniel be placed in foster care

. The court ordered Nathaniel detained in an approved foster ho me pending further hearing. The Agency considered the older children ' s foster home as a possible placement for Nathaniel , but the older children ' s caregiver declined to have Nathaniel placed with her. The Agency ' s report for the six

- month review hearing noted that Candy was visiting Nathaniel twice weekly. Nathaniel ' s caregivers supervised one of the visits and the other took place at a visitation center with Candy and the other children. The visitation center reported that many of Candy ' s visits were " unorganized " and " chaotic. " Candy would laugh when the children misbehaved and not redirect their behavior. She appeared to have difficulty managing all four children at the same time. At the six

- month review hearing , the court found Candy had made su bstantive progress with her case plan. The court continued Nathaniel ' s foster placement and Candy ' s reunification services , and ordered that Nathaniel have sibling visitation. In May 2013 , the Agency filed a report for the 12

- month review hearin g. The Agency reported that in November 2012 Candy had given birth to her fifth child , Sebastian G. , who remained in her care. Candy and Sebastian lived with the maternal grandmother. Candy had complied and made progress with her case plan. She was allowed uns upervised visitation with the children and was in the process of starting overnight visits.6

An " FFA Angels " 2 social worker expressed concerns about Candy ' s visitation with Nathaniel. Candy had transported all of the children in her vehicle although there were only five seat belts in the vehicle. She agreed to use public transportation to transport the children and later purchased a vehicle that could accommodate all of the children, but she needed to register the new vehicle . The social worker was also concerned that Candy was not bathing Nathaniel and possibly not feeding him before returning him to his foster home. Candy admitted that on two occasions she had not bathed Nathaniel before returning him

— once when they were out and she did not have enough time to bath him before having to drop him off by a certain time , and once when he had been sick and she did not want to take him out into the cold after bathing him. She said she fed Nathaniel before returning him to the foster home

. Nathaniel was deve lopmentally on track but his doctor was concerned about his low weight. At the 12

- month review hearing o n June 4, 2013 , Candy requested that trial be set on the issue of Nathaniel ' s return to her custody. The court admonished Candy

" regarding being lawf

ully permitted to drive and ensuring [Nathaniel] is properly restrained in the car. " (Capitalization omitted.) On June 10, Nathaniel ' s foster mother reported that when she met Candy at a park on June 6 to pick up Nathaniel, she saw Nevaeh, Mia, and Jesus hiding on the floor of the backseat of Candy ' s car. The foster mother waved at the three children who were hiding and they acted as if they should not have been found. The FFA so cial worker was

2 The Agency's reference to "FFA Angels" presumably was intended as a reference to Angels Foster Family Network.7

concerned that the incident indicated Candy was continuing to transport all four children together even though she knew she was not supposed to do so. The social worker was also " very concerned that [Candy] may be asking the children to ' hide ' and thus compromising their safety and asking them to be deceitful. "
A t a pretrial status conference on July 16, 2013, Candy withdrew her trial set and the court continued Nathaniel ' s foster placement and reunification services for the parents

. The court ordered that " Mother may not transport [Nathaniel] in any motor vehicl e, unless Mother has a driver ['s license ] , insurance, vehicle registration; all appropriate minor car seats, comply with California law regarding transportation and never instruct the minor to hide from the view of other vehicles. " (Capitalization omitted .) In its 18

- month review report, the Agency recommended that Nevaeh , Mia, and Jesus be placed with Candy and that Nathaniel continue to be placed in his foster home. Nathaniel had recently been diagnosed with chronic kidney disease and would need a kidne y transplant . His kidneys were functioning at only 30 percent , and his right kidney was worse than his left kidney. He was also diagnosed with failure to thrive . He was at .23 p ercent body weight for his age and needed to follow a strict diet that wa s h igh in fat and calories. Candy attended a medical appointment at Rady Children ' s Hospital, where Nathaniel was seen by the nephrology department and a dietician. She was provided a list of foods that Nathaniel should eat and a list of foods he should avo id

. The following day (August 27, 2013), Nathaniel was with Candy for an overnight visit. During the visit Candy fed Nathaniel food he was to avoid. The Agency expressed8

" extreme concerns that [Candy] is [ noncompliant ] with [Nathaniel ]' s diet. " The Agen cy noted that Candy had a history of noncompliance and would " continue to do things even when told not to.

. . . She [did] not seem to be taking [Nathaniel ]' s medical needs seriously. " Nathaniel ' s caregiver expressed concern about Candy not attending medi cal appointments and not providing Nathaniel with the special diet he required. The FFA social worker also expressed concern that Candy was not providing a nutritional diet to Nathaniel on overnight visits, not providing Nathaniel a scheduled nap time, an d not attending medical appointments regarding his newly discovered kidney disease. The children ' s court

- appointed special advocate ( CASA ) expressed similar concerns about Nathaniel in a report that she filed for the 18

- month review hearing

. The
CASA sta ted: " I have had concerns regarding Nathaniel from the beginning, as he is the youngest and the older siblings compete for [Candy ]' s attention. His recent chronic kidney disease diagnosis makes me even more concerned about his health and well

being . I f eel that if he is returned to his mother he will not receive the care he needs. The three older children are aggressive in their pursuit of attention, and the mother ' s non dependent baby is naturally the focus of both the mother and the other children.
N athaniel has neither the experience nor the vocabulary to make his needs known among the other four. I question whether he will receive the specialized diet he requires, or the medical attention he will eventually require. " The CASA stated that her conce rn was

" multiplied " because of a p rior dependency case in which Nev a e h was removed from9

Candy ' s care as a n infant because she was severely underweight and Candy was not following medical directions for her care. The Agency filed an addendum report on Octo ber 10, 2013 , with an attached letter from Natalie Martinez, a certified pediatric nurse practitioner with Sharp Rees

- Stealy who had followed Nathaniel ' s medical care for one year. Martinez noted Nathaniel had failure to thrive secondary to chronic kidney disease with renal failure . His medical goal was to gain enough weight to be eligible for a kidney transplant. Martinez reported that because Nathaniel ' s " kidneys do not filter well, he needs to be on a controlled potassium, phosphorous and sodium diet. If these minerals build up in his blood at dangerous levels, they can cause problems for his bones, heart, muscles, eyes, lungs and blood vessels. He also needs to limit his sodium to prevent water retention and control blood pressure. " Martinez noted t hat both Candy and the foster mother had been provided a detailed special diet for Nathaniel by Rady Children ' s renal clinic , which specifically excluded " fast foods

. " It had come to the medical staff ' s attention that Candy often took Nathaniel to McDonal d ' s when he stayed with her and that he was often sick with abdominal pain or diarrhea when he returned to his foster home. Martinez suggested that supervision of Nathaniel ' s diet during his visits with Candy may be required. In October 2013 , the court p laced Nathaniel ' s three older siblings with Candy . A t the Agency ' s request , the court continued Nathaniel ' s 18

- month review hearing to December 5, 2013 , to provide Candy additional services to address Nathaniel ' s medical

concerns.10

On December 3, 2013, th e Agency filed an addendum report in which it recommended that the court terminate the parents ' reunification services and set a section 366.26 hearing for Nathaniel

. Candy had not been following Nathaniel ' s special diet during her unsupervised visits wit h him. On October 18, 2013, the foster mother found a McDonald ' s flier in Nathaniel ' s lunch box and Nathaniel said he had eaten French fries and ketchup. On November 1, Nathaniel ' s daycare reported that the only thing packed for Nathaniel ' s lunch was a p eanut butter sandwich on white bread , foods that Nathaniel was to avoid. Upon questioning Candy , the Agency learned there were at least two instances of her failure to follow Nathaniel ' s diet . The Agency suspected there were more occurrences, but noted i t was " very difficult to find out what [Nathaniel] is really eating versus what [Candy] says she is feeding him. " Nathaniel ' s nephrologists were concerned that Candy ' s disregard ing Nathaniel ' s strict diet could become a problem for him. On December 11, 2013, the Agency filed a petition under section 342 , alleging , under section 300, subdivision (b), that there was a substantial risk Nathaniel would suffer serious physical harm or illness because Candy was not able to strictly adhere to the special diet h e required. The Agency filed a detention report on December 12 that addressed Candy ' s failure to adhere to Nathaniel ' s diet, and additionally noted that Nathaniel had received a bite mark on his right cheek, a bruise on his forehead, and a rash on his lef t cheek during his visitation with Candy. He suffered the bruise when Candy opened a door that he and Jesus were hiding behind and the door hit his forehead

. The Agency concluded that " [t]he risk of neglect in the mother ' s care is high and court [

- ]11

order ed services are necessary to mitigate the risk of future neglect.

. . . The mother has been educated on how to meet Nathaniel ' s special needs, however, the mother has failed to utilize the services to effectively meet Nathaniel ' s needs during unsupervised visits. " The Agency recommended that Nathaniel continue to be placed in out

- of

- home care and that the parents be ordered to participate in reunification services.
At a contested adjudication and disposition hearing on the section 342 petition on January 17, 2014 , the court found that Nathaniel continued to be a person described in section 300, subdivision (b). The court continued Nathaniel ' s foster placement and ordered additional reunification services for the parents

. The court ordered Candy to

atten d all medical appointments for Nathaniel concerning his kidney condition and to keep a food log for him

. The court found extraordinary circumstances under section 352 to continue the 18

- month date and set an 18

- month review hearing for April 3, 2014.
In a status review report filed on March 21, 2014, the Agency reported that Mia had disclosed that Jesus had sexually molested her multiple times. Candy responded appropriately and implemented a safety plan that included separating the children and monitorin g their sleeping arrangements. On April 3, 2014 , the Agency filed an addendum report in which it again recommended that the court terminate reunification services and set a section 366.26 hearing for Nathaniel. Nathaniel ' s foster mother observed Nathanie l fondling his penis on March 15 and 16, 2014. She asked him if anyone had touched his penis and he replied that both Jesus and Mia had touched it. The Agency temporarily canceled Candy ' s12

overnight visits with Nathaniel pending an investigation of the ma tter. Candy told the social worker that Jesus admitted he had touched Mia but denied touching Nathaniel. The Agency filed an addendum report on April 3, 2014 , that included a letter from the Angels F oster Family Network social worker who had worked with Nathaniel and his foster parents for one and a half years. The social worker noted that Candy had not consistently attended Nathaniel ' s medical appointments, had been late to appointments, and often did not pay attention during appointments. She had to be prompted to pay attention, and she did not take notes or ask questions about Nathaniel ' s care or condition. Candy was dismissive of Nathaniel ' s medical condition, stating that she knew " someone else who had the same thing as Nathaniel " and they " got be tter. " Candy also had remarked that s he did not believe Nathaniel was born with his kidney condition and that it was the result of being removed from her. Nathaniel ' s doctors explained to Candy that Nathaniel ' s condition would never improve. The Agency ' s assessment was that the parents were not capable of meeting Nathaniel ' s special needs or able to adequately supervise him on a full

- time basis. The Agency reported that Candy had made some progress in being able to meet Nathaniel ' s special needs, but not substantial progress. In addendum report s filed on May 7 and June 3, 2014 , the Agency reiterated that assessment and recommend ed that the court terminate reunification services and set a section 366.26 hearing. In the latter addendum, the Agency reporte d that Walmart employees called the police to report that Mia and Sebastia n had been left unattended in a van for over a half an hour. The police arrived 15 minutes later and Candy returned to the van 15 mi nutes13

after the police arrived. Thus, the childr en were unattended in the van for over one hour. The windows were rolled up and the car was not running. Sebastian was asleep in his car seat and was drenched, and Mia had sweat beads on her forehead. Candy claimed she was in Walmart for o nly 10 to 15 m inutes. She told the Agency social worker that Mia did not want to go into the store because she had just hurt her ankle at a gas station , and that she did not take Sebastian into the store because Mia asked her to leave him in the car with her. Candy ag reed to a safety plan that included never leaving the children unsupervised in the home, vehicle, or in public. The June 3 addendum report included another letter from pediatric nurse practitioner Martinez. Martinez reported that Nathaniel was " at the 1 percentile for height and weight. " He had been cleared for a kidney transplant, but to postpone that surgery as long as possible, it was of the " utmost importance " that his daily health care needs were met. In addition to his special diet and medications , Nathaniel needed to receive daily growth hormone injections that had " to be gi ven in a clean environment by a responsible person who has been trained to do this and is competent in the skill. " The injections were currently being given only by his foster mother, who had been trained to give them and whose household met the appropriate standards. Martinez also noted that it was important that Nathaniel not have infections. She stressed the need to maintain a clean environment and to avoid being around ot hers who were sick. Martinez also advised that Nathaniel should be in a safe and stable household without undue stress. In summary, Martinez stated that " Nathaniel ' s growth and developmental success

. . . is dependent on maintaining a rigorously healthy and structured environment. Since he is a14

medically fragile child, deviation from this can be detrimental to his health. Optimizing his health has a direct impact on his long [

- ] term survival and avoiding any unnecessary complications. " The court held th e contested 18

- month review hearing over two days in June 2014 and heard testimony from the Agency social worker and Candy

. The court noted Candy had made some limited progress with services concerning Nathaniel ' s medical condition, but stated " it was ins ubstantial progress on the key issues that go directly to the safety and well

- being of Nathaniel. " The court terminated the parents ' reunification services and set a section 366.26 hearing for October 23, 2014. Social worker Charese Phillips prepared th e Agency ' s section 366.26 report dated October 23 , 2014 , which included the Agency ' s recommendation that the court terminate parental rights and order adoption as Nathaniel ' s permanent plan

. Nathaniel ' s food journal showed that Candy was struggling to fol low Nathaniel ' s special diet, which required, among other things, foods that were low in sodium per serving. Phillips observed four of Candy ' s unsupervised visits with Nathaniel . I n August 2014 , she attended for approximately one hour a visit that Nath aniel had with Candy, his siblings, and the maternal grandmother at Candy ' s apartment. The apartment was warm and stuffy and smelled of urine and trash. There were numerous flies in the apartment and there was dirt on the carpet, trash piled in the trash can, and dirty dishes in the sink. The kitchen table was sticky and the children were all barefoot and the bottoms of their feet were grey with dirt. Nathaniel, Jesus, and Sebastian had difficulty sharing their toys and often became upset and cried. Wh en Candy tried to redirect them, they often did not15

listen. Candy denied that she had ever had difficulty following Nathaniel ' s diet, and complained that the diet was often changed so that foods that were allowed one day were not allowed the next. Both C andy and the maternal grandmother implied that Nathaniel was not ill and that the fos ter mother was making him sick. Phillips observed three additional unsupervised visit s between Candy, Nathaniel , and Sebastian in September 2014 at Candy ' s apartment. Na thaniel and Sebastian had difficulty sharing their toys during the visits and often became upset and cried and did not listen when Candy attempted to redirect them. During one of the visits , Nathaniel had diarrhea in his diaper and Candy was unable to fin d wipes. During the next visit Nathaniel asked to brush his teeth while Candy was dressing him. Candy could not locate his toothbrush. When Phillips arrived at Candy ' s apartment to observe a fifth visit, Candy told Phillips she was not ready

. The apart ment smelled strongly of urine and dirty diapers and there were items strewn all over the living room, including toys, clothes, and bed linens. Candy explained that Jesus made the mess when he became angry because she told him he could not play outside.
N athaniel ' s caregiver reported that Nathaniel separated from Candy at the end of visits without emotional turmoil. After visits, he was overly tired and " cranky, " and would use curse words and display more aggressive behavior than usual. When Phillips
spo ke with the caregiver about different permanent plan options for Nathaniel, the caregiver immediately indicated that she and her husband preferred to adopt Nathaniel, and in later discussions reaffirmed that she and her family were committed to offering
Na thaniel permanence through adoption.16

Phillips assessed Nathaniel to be specifically and generally adoptable and , on behalf of the Agency, recommended adoption as his permanent plan. Phillips acknowledged that Nathaniel and Candy cared for each other and t hat spending time with Candy was a fun and positive experience for Nathaniel. However, she concluded that

" [ t ] he significance of this relationship

. . . does not outweigh the benefits of Nathaniel being placed in a permanent home that has the ability to m eet his significant medical needs

. . . . Nathaniel shows no signs of emotional distress when separating from the mother, nor does he ask for her when he is with the caregivers. Furthermore, the mother ' s continued difficulty with following Nathaniel ' s str ict diet and her loose supervision of him around his siblings calls into question her judgment and capacity to remain in a parental role. " Phillips concluded that Nathaniel ' s bond with his siblings was " not so significant that it would outweigh the benefi ts of permanency for Nathaniel. He appears to enjoy spending time with his siblings, however, he does not ask for his siblings when he is not with them , nor does he have difficulty separating from them at the end of their visits. Based on Nathaniel ' s sig nificant medical needs, and the fact that he is a preschooler who has been in the dependency system for 30 of his 45 months of age, he is in critical need of the permanence and stability that adoption provides. These needs far outweigh any
detriment that severing the sibling bon d may cause Nathaniel. " The CASA filed a report dated October 23, 2014 , in which she recommended adoption as Nathaniel ' s permanent plan. The CASA observed Nathaniel in Candy ' s home twice. The CASA reported that the home appeared dirty and disorganized and although17

Candy responded to Nathaniel 's needs when he asked for something, " she did not seem interested in interacting with Nathaniel or concerned about his interactions with [the CASA] or his siblings. " The CASA concluded: " Th ough Nathaniel does have a relationship with his mother and siblings, I believe the risks of him being in an unsafe environment are greater to his health and well

- being than the separation from these family members, [whom] he has not lived with on a full

- t ime basis for the majority of his life. " On the date initially set for the section 366.26 hearing, Candy requested a trial on the issues of the parent

- child bond and the sibling bond exception. The court ordered that Nathaniel be made available for a bon ding study upon Candy ' s request and set the section 366.26 hearing for December 12, 2014.
Phi llips filed an addendum report o n November 25, 2014, noting that on October 8, 2014, the caregiver reported that Nathaniel had lice after he returned home from an overnight visit with Candy. Candy denied that she or her children had lice, but bought a new mattress and box spring and the carpet in her apartment was changed. When the caregiver picked Nathaniel up from an overnight visit on November 3, he fell asleep for four to five hours, which was unusual for him. The caregiver called Candy to ask if anything had happened during the visit. Candy told her that she had mistakenly sent Nathaniel home with the maternal grandmother ' s medication, but denied that she ha d given Nathaniel the medication. On November 9 , 2014, the caregiver reported that Nathaniel had a severe and painful diaper rash when returned from a visit with Candy. Candy told the caregiver that18

Nathaniel ' s diaper had become saturated with urine and o verflowed onto his clothing and the floor. The caregiver took Nathaniel to urgent care where he was diagnosed with a highly contagious fungal infection and prescribed a ppropriate medication

. Candy did not attend a doctor ' s appointment for Nathaniel the n ext morning. Phillips filed a second addendum report o n December 11 , 2014 , to report that on November 22, Candy took Nathaniel to the emergency room because he had been vomiting all evening, had not eaten anything, and was listless and fatigued. Nathanie l was transferred to Rady Children ' s Hospital where he was treated for dehydration and released. Section 388 petitions On November 12, 201 4 , Nevaeh, Jesus, and Mia filed section 388 petitions requesting to participate in Nathaniel ' s case and to present a rgument and evidence regarding the sibling relationship exception to adoption. On December 2, 2014, Daniel filed a section 388 petition requesting that Nathaniel be returned to his care or, alternatively, that the court order a transition plan to expand h is visitation with Nathaniel to facilitate placement with h im

. The court granted " the siblings ' request to participate in the trial[,] " but denied Daniel ' s petition. (Capitalization omitted.) Section 366.26 hearing The court held a contested section 36 6.26 hearing over two days

— December 12 and December 29 , 2014

. On the first day of the hearing the court received into evidence the section 366.26 report dated October 23, 201 4; the addendum reports filed on November 25 and December 11, 2015; and the CASA ' s report dated October 23, 2014

. The court heard testimony from social worker Phillip s, and the parties stipulated to19

testimony from Nathaniel ' s older siblings. Nevaeh ' s and Mia ' s stipulated testimony was that they loved Nathaniel and did not want him to be adopted; they wanted to live with Nathaniel; they would be sad if they could not visit Nathaniel; when he visits they play with him and watch his favorite television shows with him; and they would like to see him more than once a week. Jesus ' s stipula ted testimony was that he wanted Nathaniel

" to stay with us[;] " he liked playing and visiting with Nathaniel and let him win when they played together; he would be sad if he could not see Nathaniel anymore and would feel angry if Nathaniel " was taken away from us. " When the hearing continued on December 29, the court received into evidence a bonding study authored by Sonia Carbonell , Psy.D. , a psychologist, and her curriculum vitae. The study assessed the bond between Candy and Nathaniel. Based on her ob servations of interactions between Candy and Nathaniel and her " review of literature explaining the basis of attachment [as] part of the theoretical framework used for [her] opinion[,] " Dr. Carbonell concluded that severing Nathaniel ' s " natural parent

- chil d relationship should greatly deprive Nathaniel of a substantial, positive emotional attachment such that the child would be greatly harmed. " Dr. Carbonell noted that although the foster mother spoke to Nathaniel exclusively in Spanish, he respon ded to he r predominately in English, which is Candy ' s language of preference. Dr. Carbonell stated
that " Nathaniel ' s language preference suggests that the birth mother continues to be his primary attachment. " The court also received into evidence an Age ncy addend um report f iled on December 24, 2014. The report included criticism of Dr. Carbonell ' s bonding study and a20

paper by a psychologist entitled " Second Language Acquisition in Early Childhood, " in which the author notes that when a young child is learning two languages simultaneously, it is normal for one language to predominate as the child learns and becomes more comfortable with the second la n guage. After hearing argument on the section 366.26 issues, the court found by clear and convincing evidence that N athaniel was likely to be adopted and that none of the circumstances specified in section 366.26, subdivision (c)(1)(B) that would make termination of parental rights detrimental to him existed. The court acknowledged that termination of parental rights w ould affect Nathaniel ' s sibling relationships, but found that maintaining those relationships did not outweigh the benefits of adoption. The court acknowledged there was " a bond or a relationship " with Candy but thought Nathaniel had developed more of a m other

- child relationship with his foster mother. The court concluded: "

. . . I do not find that it has been established

. . . or there is evidence supporting a conclusion that severing a natural parent [

- ] child relationship would deprive Nathaniel of a s ubstantial positive emotional attachment such t hat he would be greatly harmed. " The court found that Dr. Carbonell ' s conclusion to the contrary was largely " based on theory and not so much on what is before the [c] ourt. " Considering Nathaniel ' s special ne eds, the court added: " I think it would be a travesty for him if he remained in a permanent plan that was foster care, quite frankly, and the in stability of foster care. " The court re jected a suggestion by Candy ' s counsel that " we should grill the foster mother as to whether she really meant that she didn ' t

--21

that she wouldn ' t consider legal guardianship first, I note the benefits of adoption for this child are extraordinary . Permanence is extraordinary. " The court terminated parental rights and referre d Nathaniel to the Agency for adoptive placement.
DISCUSSION

I. Beneficial Parent

- Child Relationship Exception Candy contends the court erred in finding that there was not a beneficial parent

child relationship between her and Nathaniel within the meanin g of section 366.26, subdivision (c)(1)(B)(i) that precluded the termination of her parental rights. " ' At a permanency plan hearing, the court may order one of three alternatives: adoption, guardianship or long

- term foster care. [Citation.] If the dep endent child is adoptable, there is a strong preference for adoption over the alternative permanency plans. ' [Citation.] ' Once the court determines the child is likely to be adopted, the burden shifts to the parent to show that termination of parental ri ghts would be detrimental to the child under one of the exceptions listed in section 366.26, subdivision (c)(1). [Citations.] Section 366.26, subdivision (c)(1)(B)(i), provides an exception to termi nation of parental rights when " [t]he parents have maint ained regular visitation and contact with the child and the child would benefit from continuing the relationship. " ' " ( In re G.B. (2014) 227 Cal.App.4th 1147, 1165 ( G.B. ) .) This court has interpreted " the ' benefit from continuing the [ parent[

- ]child ] rel ationship ' exception to mean the relationship promotes the well

- being of the child to such a degree as to outweigh the well

- being the child would gain in a permanent home22

with new, adoptive parents. In other words, the court balances the strength and qual ity of the natural parent[

- ]child relationship in a tenuous placement against the security and the sense of belonging a new family would confer. If severing the natural parent[

- ]child relationship would deprive the child of a substantial, positive emotion al attachment such that the child would be greatly harmed, the preference for adoption is overcome and the natural parent ' s rights are not terminated. " ( In re Autumn H. (1994) 27 Cal.App.4th 567,
575 ( Autumn H

. ) .)

" A parent asserting the parental benefit exception has the burden of establishing that exception by a preponderance of the evidence. [Citation.] It is not enough to show that the parent and child have a friendly and loving relationship. [Citation.] ' " Interaction between [a] natural parent an d child will always confer some incidental benefit to the child

. . . . " ' [Citation.] For the exception to apply, ' a parental relationship is necessary[.] ' [Citation.] ' " While friendships are important, a child needs at least one parent. Where a bio logical parent

. . . is incapable of functioning in that role, the child should be given every opportunity to bond with an individual who will assume the role of a parent. " ' " ( In re J.C. (2014) 226 Cal.App.4th 503, 529 ( J.C. ) .) The court ' s finding on

t he issue is reviewed under the substantial evidence rule. ( Autumn H., supra, 27 Cal.App.4th at p. 576.) Under that rule " we must accept the evidence most favorable to the order as true and discard the unfavorable evidence as not having sufficient verity to23

be accepted by the trier of fact. " ( In re Casey D. (1999) 70 Cal.App.4th 38, 53 ( Casey
D. ) .) 3 We conclude that Candy has not met her burden of establishing that the beneficial relationship exception to adoption applies. There is ample evidence in the record to support the finding that Candy failed to assume a parental role in Nathaniel ' s life , especially with respect to Nathaniel ' s special medical need s. In considering whether Candy occupied a parental role , and in weighing the harm Nathaniel would s uffer from severance of the Candy ' s parental relationship against the benefits he would gain from being adopted by his foster parents, the court ' s primary focus was properly on Nathaniel ' s fragile medical condition and special needs. Nathaniel ' s medical pr oviders, through pediatric nurse Martinez, emphasized the

" utmost importance " of meeting his health care needs, which include taking medications, receiving daily growth hormone injections, strictly adhering to a special diet, and living

3 The Agency articulat es the hybrid standard of review applied in In re Bailey J. (2010) 189 Cal.App.4th 1308 ( Bailey J. ) and J.C. , supra, 226 Cal.App.4th 503. In published opinions, this court has consistently applied the substantial evidence standard of review to challenges to orders determining the applicability of exceptions to adoption. (See, e.g., Autumn H. , supra , 27 Cal.App.4th at p. 576 ; In re L.Y.L. (2002) 101 Cal.App.4th 942 , 947 ; In re Megan S. (2002) 104 Cal.App.4th 247, 250

- 251; In re Christopher L. (2006) 143 Ca l.App.4th 1326, 1333

- 1334 ; In re Michael G. (2012) 203 Cal.App.4th 580, 593

- 594 ( Michael G. ) .) W e need not decide whether to apply the hybrid standard in this case because applying that standard of review would not result in a different outcome. The anal ysis is essentially the same u nder either standard of review because " '[e] valuating the factual basis for an exercise of discretion is similar to analyzing the sufficiency of the evidence for the ruling

. . . . Broad deference must be shown to the trial j udge. The reviewing court should interfere only " ' if [it] find[s] that under all the evidence, viewed most favorably in support of the trial court's action, no judge could reasonably have made the order [under review].' " ' " ( In re Jasmine D. (2000) 78 Cal.App.4th 1339, 1351.)24

in a clean and safe environment. Martinez explained that Nathaniel is a " medically fragile " child whose growth, developmental success, and long

- term survival depend on his being in a " rigorously healthy and structured environment. " There was s ubsta ntial evidence that Candy repeatedly fell short of meeting Nathaniel ' s critical medical needs. She repeatedly failed to adhere to his strict diet and exposed him to unsanitary conditions. During a visit that Phillips observed, there were flies in Candy ' s apartment, dirt on the ca rpet, trash piled in the trash can, and dirty dishes in the sink. Nathaniel returned to his caregiver from a later visit with a painful diaper rash and fungal infection caused by a saturated diaper. During another visit Candy took Nathaniel to the emerge ncy room where he was treated for dehydration. He also received a bite mark on his right cheek, a bruise on his forehead, and a rash on his left cheek during his visitation with Candy. The CASA reported that Nathaniel had returned to his foster home from visits with Candy " with a fat lip, exhausted, and with diarrhea. " There was evidence that Candy did not take Nathaniel ' s kidney condition seriously despite the information she was provided about the seriousness of the condition

. She did not consistently attend his medical appointments and was late for appointments . She had to be prompted to pay attention and did not take notes or ask questions about Nathaniel ' s condition during appointments. She was dismissive of Nathaniel ' s medical condition, stating t hat she knew " someone else who had the same thing as Nathaniel " and they " got better. " She said she did not believe Nathaniel was born with his kidney condition and that it was the result of being removed from her.25

In addition to evidence that Candy negl ected Nathaniel ' s medical needs, there was evidence that she had other lapses in judgment that pu t her children at risk of harm. She had transported her children in a vehicle without enough seat belts for all of them and instructed them to hide on the veh icle floor from Nathaniel ' s foster mother to conceal that fact

. She left Mia and Sebastian unattended in her vehicle van for over one hour in a Walmart parking lot. Nevaeh had been removed from Candy ' s care as an infant in a prior dependency case because she was severely underweight and Candy did not follow medical directions for her care. Phillips assessed Candy as being incapable of meeting Nathaniel ' s special needs and reported that her " continued difficulty with following Nathaniel ' s strict diet and her loose supervision of him around his siblings calls into question her judgment and capacity to remain in a parental role. " The CASA expressed similar concern s that if Nathaniel were returned to Candy, he would not receive the care he needs

. She observ ed that Candy seemed to be struggling to meet her family ' s needs while having her other four children in her care . The CASA believed that " the addition of Nathaniel into this situation on a permanent basis, especially due to his medical condition, would o nly exacerbate [Candy ] ' s inability to keep her children safe and healthy. " She further believed that Nathaniel was doing as well as he was " because of the stable environment
of his foster home [] that he is in six nights a week. If not receiving his medic ation regularly and eating the appropriate diet, Nathaniel could quickly go into kidney failure and require dialysis and transplant at a much younger age than necessary. " The CASA noted that although Nathaniel had a relationship with Candy and his sibling s, he had not26

lived with them on a full

- time basis for most of his life. She concluded that Nathaniel ' s being in an unsafe environment was a greater risk to his health and well

- being than separation from Candy and his siblings. There was substantial evid ence that Nathaniel was thriving in his foster home

. The foster mother reported that Nathaniel show ed no signs of emotional distress when separating from Candy at the end of visits. The CASA reported that the foster parents

were " very attentive caregiver s, and are engaged in ensuring Nathaniel receives the medical care he needs. " The foster mother was trained and competent to give Nathaniel his daily growth hormone injections , which had to be given in a clean environment, and her household met the necess ary cleanliness standards

. The CASA believed Nathaniel ' s foster placement was a " wonderful environment for Nathaniel and has proven to benefit his growth and development , along with his overall health. " Phillips reported that both foster parents loved Na thaniel unconditionally and made meeting his medical needs a top priority. Her assessment was that Nathaniel ' s place ment was a safe and nurturing home with caregivers who would consistently meet his medical, developmental, educational, and emotional needs

. In its oral ruling, the court noted that Nathaniel would need a kidney transplant in the future and stated it had " relied on the medical assessments

. . . of the need

. . . of being in a clean home. A home that will keep him infection free, that follo ws routines and that can meet his medical needs, including the administration of medications to
him

. . . . And ultimately be a home that can also meet his needs as he ultimately recovers from a kidney transplant

. . . . " The court f urther noted " how deb ilitating it is for27

[Nathaniel ] when the routine is not followed, when the diet is not acknowledged and followed, when he ' s exposed to filth or germs that can make him sick, or a fungus that can make him sick and perhaps unavailable should he get to the p oint whe re he ' s in need of a transplant. [¶]

. . . And so I note in terms of his physical and medical needs, [Nathaniel] deserves a permanent, loving home [and caregiver] that can say I will stick by you no matter how sick you get, what the needs are [

— ][ w ] ho can be with him when procedures are painful. [¶]

. . . H e ' s different now than other almost [

- ] four

- year - olds

. . . . He ' s a child that still has to be watched like a much younger child because of the restrictions on his diet, because of the need of c leanliness and order. " The court found that Nathaniel had " thrived " and " don e exceedingly well " in his current caregivers ' home, which had " provided him permanence. " The court found that the benefits of Nathaniel being adopted by someone who is " mindful o f all of his whole constellation of needs is extraordinary[,] " and further found that " the benefits to date that he ' s enjoyed under the [c] ourt ' s supervision with a stable, loving and nurturing and medically mindful home are particularly extraordinary. " T he evidence before the court strongly support ed these findings. Candy cites Dr. Carbonell ' s bonding study as expert evidence supporting a finding that she and Nathaniel share a strong attachment and that Nathaniel would suffer great
harm if their relation ship were severed. The court stated that it had carefully considered Dr. Carbonell ' s curriculum vitae and bonding study. The court noted that Dr. Carbonell reviewed only the Agency ' s detention report, section 366.26 report, and April 3, 2014 , addendum re port and thus did not have " the benefit of reviewing the many, many more28

reports, even that preexist the [section 366. ] 26 report. " As an example, the court noted Dr. Carbonell did not have the benefit of much of the information regarding the physical effe cts of Nathaniel ' s past visitation with Candy, including " illnesses or coming back with bruises, bumps, fungal infection relating to a dirty diaper, very severe diarrhea, having to be sent to the hospital. A failure to give appropriate and careful supervi sion of the child while he was in the mother ' s home. " The court believed that Dr. Carbonell ' s assessment

was " affected by the limited amount of information that she had. " The court further noted that Dr. Carbonell viewed this case " as a competition or a conflict of interest between the foster mother and the birth mother. " The court disagreed with that view and stated that it thought " Dr. Carbonell jumped to a conclusion without having reviewed [all of the relevant information ]. " The court found that " th e multitude of evidence " did not support Dr. Carbonell ' s view that Candy ' s struggle to comply with medical directives was in part due to the foster mother ' s behavior. The court stated that it had " significant concerns that Dr. Carbonell, having not review ed all of the information in the case, is essentially seeing this through a lens of [it being] foster mother versus mother.

. . . And so in this [c] ourt ' s mind,

. . . it lessens the credibility of [Dr. Carbonell ' s] report. " The court was " not overly pers uaded " by Dr. Carbonell ' s conclusion that Nathaniel ' s language preference indicated his primary attachment was to Candy, noting that Dr. Carbonell did not support that conclusion with any citation to authority. It is the trial court ' s role to assess the cr edibility of witnesses and resolve the conflicts in the evidence ; we cannot reweigh the evidence , second

- guess the trial court ' s credibility determinations , or substitute o u r judgment for that of the trial court

. ( Casey29

D. , supra, 70 Cal.App.4th at p p . 52

- 53 .) The juvenile court was entitled to give Dr. Carbonell ' s opinion little weight as not being based on a review of the entire record

. Further, as the Agency ' s and Nathaniel ' s counsel both argued and the court observed, none of the research that Dr. Ca rbonell cited in her bonding study addressed language preference as an indicator of a primary attachment. Thus, her suggestion that Nathaniel ' s preference to speak in English evidences a primary attachment with Candy was unfounded. The court was entitled to give great er weight to Phillip s ' s opinions and

assessments ( i d. at p. 53 ) , and to find the CASA credible. S ubstantial evidence supports the court ' s finding that there was not a parent

- child relationship between Candy and Nathaniel within the meaning o f section 366.26, subdivision (c)(1)(B)(i) that precluded the termination of parental rights.

II. Beneficial Sibling Relationship Exception Candy and Jesus contend that the court erred in finding the sibling relationship exception to termination of pare ntal rights and adoption under section 366.26, subdivision (c)(1)(B)(v) did not apply. As noted, " ' [o] nce the court determines the child is likely to be adopted, the burden shifts to the parent to show that termination of parental rights would be detrime ntal to the child under one of the exceptions listed in section 366.26, subdivision (c)(1). ' " ( G.B. , supra, 227 Cal.App.4th at p. 1165.) " ' The statutory exceptions merely permit the court, in exceptional circumstances [citation], to choose an option ot her than the norm, which remains adoption. ' " ( In re Hector A. (2005) 125 Cal.App.4th 783, 791.)30

" The sibling relationship exception applies where the juvenile court finds that

' substantial interference with a child ' s sibling relationship ' is a ' compelli ng reason ' to conclude that adoption would be detrimental to the child. In making this determination, the court should take into consideration ' the nature and extent of the relationship, including, but not limited to, whether the child was raised with a s ibling in the same home, whether the child shared significant common experiences or has existing close and strong bonds with a sibling, and whether ongoing contact is in the child ' s best interest, including the child ' s long

- term emotional interest, as comp ared to the benefit of legal permanence through adoption. ' (§ 366.26, subd. (c)(1)(B)(v).) " ( Bailey J. , supra, 189 Cal.App.4th at p. 1317.) " A sufficiency of the evidence standard of review applies to the sibling relationship exception. " ( In re D.M. (2 012) 205 Cal.App.4th 283, 291 ( D.M. ) .) The statutory language requiring the court to find a compelling reason to determine that substantial interference with a sibling relationship would be detrimental to the child creates " a heavy burden for the party opp osing adoption.

. . . Furthermore, the language focuses exclusively on the benefits and burdens to the adoptive child, not the other siblings

. The court is specifically directed to consider the best interests of the adoptive child, not the siblings, and must ultimately determine whether adoption would be detrimental to the adoptive child, not the siblings. " ( In re Daniel H. (2002) 99 Cal.Ap p.4th 804, 813 ( Daniel H. ) , italics added .) " [A]pplication of the sibling relationship exception will be rare, part icularly when the proceedings concern a young child

. . . whose need for a competent, attentive and caring parent is paramount. "31

( Michael G. , supra, 203 Cal.App.4th at p. 593; In re Valerie A. (2007) 152 Cal.App.4th 987, 1014.) In the present case, the co urt found that maintaining Nathaniel ' s sibling relationships did not outweigh the benefits of adoption. The court stated it had considered the statutory factors, including the fact that Nathaniel had lived with his three older siblings for the first 15 of the 47 months of his life, and had been having overnight visits with his siblings during the past year. The court also considered the nature of Nathaniel ' s sibling relationships as reflected in the reports of his visitation and noted that

" Nathaniel clea rly enjoys his visitation with his siblings. " The court concluded: " And having considered all of the factors and noting the extreme benefits of legal permanence and stability through adoption, I do not find that

. . . the sibling relationship exception h as been demonstrated. [¶] I do not

. . . find that it has been demonstrated maintaining the sibling relationship outweighs the benefits of adoption. The court acknowledged that termination of parental rights would affect Nathaniel ' s sibling relationship s, but correctly noted, " That ' s not the primary focus. I ' m more focused on the balancing in terms of whether the benefits of adoption outweigh the maintenance of the sibling relationship and having taken into consideration everything that the statute requ ires the [c] ourt to do. " The court found that the benefit Nathaniel would gain from being adopted by his foster parents was " extraordinary, " and that the benefits he had " to date

. . . enjoyed

. . . with a stable, loving and nurturing and medically mindfu l home are particularly extraordinary. " The court stated it was " mindful of the impact on [the siblings], but the focus of this32

particular hearing is the impact on

. . . Nathaniel, so I do not find that [the sibling relationship] exception exists. "
T he co urt ' s assessment was reasonable and supported by substantial evidence. As this court has noted, the juvenile court " ' must balance the beneficial interest of the child in maintaining the sibling relationship, which might leave the child in a tenuous guard ianship or foster home placement, against the sense of security and belonging adoption and a new home would confer. ' " ( D.M., supra, 205 Cal.App.4th at p. 293.) In doing so here, the court properly consider ed Nathaniel ' s best interests rather than the si blings ' best interests ( Daniel H. , supra, 99 Cal.Ap p.4th at p. 813), and reasonably determine d that adoption would be more beneficial than detrimental to Nathaniel , notwithstanding his sibling relationships. In addition to being a young child, Nathaniel
h as a life

- threatening medical condition that makes his need for " competent, attentive and caring " parents e specially " paramount. " ( Michael G., supra, 203 Cal.App.4th at p. 593.) The court ' s finding that the benefit Nathaniel would gain from adoption

outwe ighed any detriment he would suffer from severing his sibling relationships is amply supported by the above

- noted evidence regarding Nathaniel ' s visitation with his siblings, the evidence that Candy repeatedly had difficulty following Nathaniel ' s strict di et and otherwise meeting his special medical needs , the evidence that her home environment increased the risk s to his health and well

- being, and the evidence that his foster parents provided him excellent care and were attentive to his medical and other

ne eds

. Nathaniel was a medically fragile child who needed a safe and clean environment to help prevent him from getting infections. During his visits with his siblings, he had33

sustained scratches and bruises, acquired a fungal infection, and been treated f or dehydration. Phillips reported that although Nathaniel enjoyed spending time with his siblings, he did not ask for them when they were apart and did not have difficulty separating from them at the end of visits. She also reported that that both foster parents loved Nathaniel unconditionally and made meeting his medical needs a top priority. Her assessment was that Nathaniel ' s placement was a safe and nurturing home with caregivers who would consistently meet his medical, developmental, educational, an d emotional needs. Based on Phillips ' s assessment and the other evidence before the court, the court

re asonably found that the benefit Nathaniel would gain from the permanency of adoption substantially outweighed any benefit he would gain from maintaining his sibling relationships

. Jesus contends the court ' s finding on the sibling relationship exception is not supported by substantial evidence because it was large ly based on Phillips ' s " inherently improbable " opinion that the exception did not apply

. He a rgue s that Phillips ' s opinion

was " inherently improbable " because she spent only one hour observing Nathaniel with all of his siblings and did not " rely on a broad or deep understandi ng of the scientific literature. " Phillip s ' s opinion was not inherently i mprobable evidence. A witness ' s statements are properly rejected as inherently improbable where there exists " ' either a physical impossibility that they are true, or their falsity [is] apparent without resorting to inferences or deductions. [Citations.] Conflicts and even testimony which is subject to justifiable suspicion do not justify the reversal of a judgment, for it is the exclusive34

province of the trial judge or jury to determine the credibility of a witness and the truth or falsity of the facts upon which a determination depends. ' " ( Evje v. City Title Ins. Co. (1953) 120 Cal.App.2d 488, 492.) Evidence may be disregarded as inherently improbable only when it is " wholly unacceptable to reasonable minds

. . . . " ( Kircher v. Atchison, T. & S.F.R. Co. (1948) 32 Cal.2d 176, 183 ; T amble v. Downey (1951) 104 Cal.App.2d 810, 812 [ " Inherent improbability only exists when no reasonable person could believe the testimony. " ]. ) Nothing in Phillips ' s reports and assessments meets the cas e law definition of

" inherently improbable " evidence

. Phillips ' s opinion regarding the sibling relationship exception was based on her review of the entire file, her experience as an Agency social worker , her firsthand observations of Candy and Nathaniel during four visits, i ncluding one where all four siblings were presen t , and her conversations with Candy and other relevant parties. The fact that Phillips ' s opinion was not expressly based in part on scientific literature does not render it inherently improbable or lacking i n evidentiary support. The court reasonably relied on Phillips ' s opinion in deciding whether the sibling relationship exception applied, and it is disingenuous to suggest that no reasonable person could find her opinion credible. Substantial evidence sup ports the court ' s finding that the sibling relationship to adoption did not apply.35 DISPOSITION The order selecting adoption as the permanent plan for Nathaniel and terminating parental rights is affirmed.

HALLER, J. WE CONCUR:

HUFFMAN, Acting P . J.

M C DONALD, J.