Court Opinion

ID: 9954610
Source: CourtListenerOpinion
Date Created: 2024-03-26 17:03:59.923925+00
Date Added: 2024-06-11T08:11:58.893462
License: Public Domain

Filed 3/26/24 In re Jacob W. CA2/5
   NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions
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IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

                         SECOND APPELLATE DISTRICT

                                        DIVISION FIVE

 In re JACOB W. et al., Persons                                    B326065 c/w B326744
 Coming Under the Juvenile Court                                   (Los Angeles County
 Law.                                                              Super. Ct. No. 22CCJP03910 A-D)

 LOS ANGELES COUNTY
 DEPARTMENT OF CHILDREN
 AND FAMILY SERVICES,

           Plaintiff and Respondent,

           v.

 S.S. et al.,

           Defendants and Appellants.

     APPEAL from orders of the Superior Court of Los Angeles
County, Stephen C. Marpet, Juvenile Court Referee. Affirmed.
     John Benjamin Ekenes, under appointment by the Court of
Appeal, for Defendant and Appellant S.S.
      Paul Couenhoven, under appointment by the Court of
Appeal, for Defendant and Appellant M.W.
      Dawyn R. Harrison, County Counsel, Kim Nemoy,
Assistant County Counsel and Kelly G. Emling, Deputy County
Counsel.
                 ____________________________

       S.S. (mother) has four boys, who are the children at the
heart of the juvenile court proceedings. The two younger boys are
Noah (born April 2017) and Ryan (born April 2018). Noah and
Ryan’s father, C.W., is not a party to the current appeal. The two
older boys are Jacob (born February 2008) and Justin (born
November 2009), and their father is appellant M.W. (whom we
refer to as “father”). On December 14, 2022, the juvenile court
declared all four children to be dependents under Welfare and
Institutions Code section 300, subdivisions (b)(1) and (j),1 and
removed them from parental custody. The two bases for
dependency jurisdiction were: (1) mother and father’s medical
neglect of Justin, specifically their failure to take him to medical
appointments in light of his Type 1 diabetes diagnosis, and
mother’s refusal to be trained to manage his diabetes and to
provide his school with insulin (counts b-1 and j-1); and (2)
mother’s medical neglect of Noah, who was diagnosed with
anemia, for failing to take him to scheduled medical
appointments. Mother and father filed separate appeals.2

      1 All further statutory references are to the Welfare and
Institutions Code unless otherwise indicated.

      2 Father’s appeal is B326744.   Mother’s appeal is B326065.

                                  2
Having consolidated the two appeals by separate order, we
resolve both appeals in this opinion.
      On appeal, father challenges the jurisdictional findings
against him, relating to Justin’s diabetes. Mother separately
appeals the jurisdictional findings as to both Justin and Noah, as
well as the order removing all four children from parental
custody. In addition, mother contends the juvenile court and the
Los Angeles County Department of Children and Family Services
(the Department) did not comply with the initial inquiry
requirements of the Indian Child Welfare Act of 1978 (ICWA) (25
U.S.C. § 1901 et seq.) and section 224.2, subdivisions (a) and (b).
We affirm the juvenile court’s December 14, 2022 orders.

      FACTUAL AND PROCEDURAL BACKGROUND

      In the time frame before they were detained from parental
custody, all four children were living with mother, who was their
primary caregiver. Justin, Noah, and Ryan all had physical
exams in August of 2021. Noah was diagnosed with anemia, but
was a no-show for a scheduled three-month follow-up visit, as
well as for his five-year well child visit. Ryan, who had asthma
and a speech delay, missed a follow up appointment in November
2021.
      On January 30, 2022, Justin was hospitalized with Type 1
diabetes, and was not discharged from the hospital until
February 9, 2022. The hospital social worker made a referral to
the Department after Justin’s discharge was delayed because
mother had not yet taken the training in how to care for Justin’s
diabetes. The referral was closed after mother received the
required training.

                                 3
       In March 2022, a new referral concerning potential
domestic abuse by mother’s male companion was also closed after
mother demonstrated her ability to protect the children; mother
left the male companion and was planning to move to a new
apartment or to Sacramento to be closer to relatives. The
investigating social worker for these two closed referrals noted
that mother refused to sign consent forms or to submit to drug
tests, and described mother as a conspiracy theorist with a
distrust of the dependency system. Mother was initially resistant
to Department involvement with the family, but was cooperative
after the social worker was able to build a rapport with her. The
fathers were not involved with the family, and mother struggled
keeping up with the children.
       Justin’s school had received medical orders concerning his
diabetes diagnosis on February 16, 2022, but when the school
tried to inform mother that Justin was missing supplies for his
diabetes monitoring and treatment, mother’s voicemail was full.
School records show a pattern of Justin being absent or not
reporting to the nurse’s station for blood sugar testing and
administration of insulin. Between February and July 2022,
Justin attended some medical appointments, mostly with a
diabetes nurse, but missed both in person and virtual
appointments with endocrinology. Justin’s prescription for
Lantus insulin was decreased in March 2022, but it appears that
the school did not learn of the change in prescription until May
when the school called the doctor’s office for updated orders.
       In early August 2022, the Department received a new
referral for general neglect, based on concerns that the younger
children lacked proper supervision and the older children were
observed smoking marijuana. A different social worker, named

                               4
Delino, visited mother’s apartment complex on August 18, 2022,
and found the four children at home without mother. When
Delino reached mother by phone, mother said everything was fine
and the Department needed to leave her alone. Delino explained
the concerns and emphasized to mother the need to meet her in
person and to interview the children. Mother then took several
steps to evade scrutiny, first agreeing to meet Delino and then
instructing the children to leave the apartment and join her in
her car where she was waiting outside. When Delino followed the
children, mother drove around, directing the children to meet her
at a different location; mother’s instructions led the children to
cross the street, putting them in potential danger. Mother
disregarded Jacob’s request that mother talk to Delino.
Eventually, Delino met maternal grandparents, who confirmed
mother’s identity. Mother spoke with Delino briefly, first
objecting to Delino’s involvement, then explaining why she was
too busy to meet, and ultimately agreeing to meet the following
week.
       The next day, August 19, 2022, Delino tried to meet mother
at a scheduled doctor’s appointment for Justin’s physical. Mother
first said she would not be there, as her son was refusing to go.
Delino informed mother that failure to attend medical
appointments would be a concern, given the Department’s prior
investigation. Mother arrived with the two younger children in a
stroller, about 40 minutes late. Jacob was dropped off about five
minutes later, making statements that appeared to be the result
of coaching by mother, giving attitude and saying he didn’t know
why he had to be there. Mother commented that she could not
force her children to go to the doctor if they did not want to come.

                                 5
Mother rescheduled the appointment, as a physical was needed
for her son to play sports.
       Delino spoke to the doctor, who explained that there were
significant concerns regarding Justin, who was considered
medically fragile based on his recent Type 1 diabetes diagnosis,
which would require lifetime monitoring and insulin medication.
The doctor explained that the condition can be life threatening if
Justin’s glucose levels are not monitored, and his need for insulin
could be compared one’s need for oxygen. The doctor noted that
Justin had seen the registered nurse, but had missed two
appointments with the endocrinologist on April 25, 2022 and
July 12, 2022. Mother had a history of not showing up for the
children’s follow up appointments. Mother was instructed in
August 2021 to bring Noah to a follow up appointment for anemia
in three months and a well child visit in one year, but had not.
Ryan had a pending speech referral and was due for a physical.
       Delino met with mother on September 1, 2021 and outlined
the concerns about missing Justin’s endocrinology appointments
and not providing the school with medication. Mother denied
Justin was sick, stating he had lost 60 pounds and the school had
said he does not need medicine. She claimed she had only missed
one appointment. When Delino explained to mother that she was
being given the opportunity to resolve the concerns and asked
mother to complete a drug test to verify her sobriety, mother
grew more reactive and erratic.
       While the Department’s investigation was ongoing, a new
referral was generated on September 8, 2022, because Justin had
not been seen by a doctor in four months and had lost 60 pounds
for unknown reasons, and because mother had refused to provide
insulin to the school. Delino could not make contact with mother,

                                6
either in person or by phone, and the children’s day care provider
and football coach had not seen the children since September 5,
2022. The school nurse reported that she last checked Justin’s
blood sugar on September 1, 2022, but had not seen Justin since.
       On September 13, 2022, mother provided the endocrine
registered nurse, George Tobo, a glucose meter that showed only
five readings for the prior four weeks. Although the glucose
readings were good, the hospital could not confirm their accuracy,
and mother refused to have Justin do a blood test that would
check his A1C levels for the past six months, stating she did not
have time. Mother returned to Tobo later the same day, asking
for a doctor’s letter stating that Justin did not need insulin.
When Tobo explained that was not possible, mother asked for a
letter that Justin’s medication had been lowered. Contrary to
mother’s assertion that Justin had lost 60 pounds, Justin’s
weight had changed from 220 pounds in January 2022 to 208
pounds in September 2022, five pounds higher than his weight in
May. Father told Tobo that mother was responsible for Justin,
and father would not take Justin to the hospital. Tobo
encouraged mother and Justin to have Justin wear a glucose
monitor for two weeks and have the readings reviewed by a
doctor, but was concerned that mother was avoidant and would
not follow doctor’s orders.
       A school counselor at Justin’s school reported that he has
had behavioral issues since the third or fourth grade, including
outbursts of anger, but when individual counseling was offered to
provide him with healthy coping skills, mother refused services.
Every time the school reached out, mother was combative and
refused to take accountability, instead blaming the school for
racially targeting her son. The children were chronically absent,

                                7
and mother refused to take accountability or respond in an
appropriate manner.
      Delino contacted various relatives to investigate placement
options. Delino was unable to contact father, and father’s wife
reported she and father had a one-bedroom apartment and were
in no position for the children to live with them. Paternal great
aunt was willing to be a placement of last resort, and said she
would encourage mother to cooperate with the Department.
Maternal grandmother, who was also diabetic, insisted that
Justin no longer had diabetes. She was unable to take the
children as she had her own caregivers and lived in a one-
bedroom apartment. Paternal grandfather and his girlfriend
were willing to care for the children.
      At a family engagement meeting on September 20, 2022,
paternal relatives were willing to provide support for Justin’s
medical needs and the other children’s educational needs. They
acknowledged the need for cooperation with the Department and
with mother to support the children’s needs and prevent removal.
Mother arrived to the family engagement meeting two hours late;
she agreed to take the children back to school and take Noah and
Justin for bloodwork to help doctors determine their medical
needs.
      Justin and his siblings returned to school on September 21,
2022; they stayed for only three hours before mother reportedly
took Justin to the doctor. All the children were absent the
following day. Justin completed his bloodwork, and was
scheduled to see a doctor on October 3, 2022 to review the results.
      On September 23, 2022, the Department conducted an
emergency child and family team meeting to address concerns
noted during the investigation, as a last effort to keep the

                                8
children with mother and prevent removal. Mother mistrusted
social worker Delino, but appeared cooperative, signing consent
forms. Mother was concerned about a neighbor who had
threatened to kill her and her children; she had an upcoming
hearing and was looking for housing. Delino said the plan would
not work without knowledge of the children’s whereabouts. On
September 27 and 28, 2022, mother spoke to Delino, but was
evasive about her whereabouts, stating she was being followed
and harassed, and could not go back to her residence.
       On September 30, 2022, the court issued a warrant to
remove the children from mother’s custody. The warrant
application expressed concern that mother had demonstrated a
lack of understanding of her children’s medical needs, and was
combative with both the medical and school system, as well as
evasive and resistant with the social worker’s efforts to address
concerns.
       On October 3, 2022, a doctor confirmed that Justin’s A1C
levels were good and his diabetes was under control. The doctor
requested a follow up appointment in two weeks to further
assess, and if Justin’s levels remained good, his medication
dosage would be lowered. The removal warrant was executed on
October 3, 2022, in the hospital parking lot after Justin’s doctor’s
visit. The children were placed with paternal grandfather and
his girlfriend.
       On October 5, 2022, the Department filed a petition
alleging the children were subject to dependency jurisdiction
under section 300, subdivisions (b)(1) and (j), based on four
separate counts. Count one related to mother and father’s
medical neglect in connection with Justin’s diabetes diagnosis.
Count two related to mother’s medical neglect of Noah and his

                                 9
anemia diagnosis. Count three alleged that mother’s male
companion had physically abused Justin. Count four alleged
father was unwilling to provide the children with ongoing care,
supervision, and necessities of life.
      At the detention hearing on October 6, 2022, the court
scheduled a no-time-waiver adjudication for October 27, 2022.
The adjudication was later continued to December 14, 2022, and
the court ordered the Department to file a supplemental report
before the continued hearing on parents’ progress and the
possibility of a voluntary contract under section 301 or section
360, subdivision (b), both of which authorize the Department to
provide a program of supervision to protect a child, either with or
without a finding of dependency jurisdiction, but without a
disposition order.
      In an interview with mother on October 17, 2022, mother
acknowledged that Justin missed appointments on April 25, 2022
and July 12, 2022, but claimed that the fault lay with Justin, who
refused to go to those appointments. She agreed Justin would
require lifelong monitoring, but said that based on his last
doctor’s visit, he only required insulin as needed.
      In an interview with father on October 26, 2022, he said he
had taken Justin and Jacob to the doctor on October 25, 2022,
and he was trying to enroll in a diabetes class.
      The children were interviewed on November 9, 2022. Jacob
and Justin were happy living with paternal grandfather, and felt
good about being closer with father, but they wanted to return to
live with mother eventually. Jacob noted that Justin still needed
more support, as he was embarrassed about his diabetes and
having to go to the nurse. Justin confirmed that he gets
frustrated with his medical condition, stating he was tired of the

                                10
doctor’s visits and embarrassed about having to go to the nurse at
school.
      On December 7, 2022, Delino conducted a conference call
with Tobo and the hospital social worker. Both continued to voice
concerns that the family still did not appear to grasp the
seriousness of Justin’s diagnosis, and the need for follow up care
for the children. Noah had not yet seen a specialist for his
anemia, despite a well child examination on August 29, 2022.
Tobo in various ways to work with the family but it had been
extremely challenging. Tobo obtained a Dexcom monitor, as an
alternative to finger prick glucose tests, which mother agreed to
in October, but while the machine is supposed to take readings
every 1-5 minutes, it only had four readings at a follow up visit.
Despite being repeatedly told that Type 1 diabetes is a life-long
condition, mother continued to believe either Justin had been
healed by weight loss, or that the hospital had misdiagnosed him.
Father and paternal grandfather had diabetes training scheduled
but not yet completed. No one in the family had followed through
on a referral to therapy to help Justin cope with his diagnosis.
      In an interim review report filed in December 2022, the
Department recommended the family would benefit from
reunification services, and the case was not suitable for a
voluntary supervision arrangement under sections 301 or 360,
subdivision (b), because mother failed to utilize or engage in
previously offered services, and neither mother nor father had
made any significant changes to address the hospital’s prior
concerns.
      At the jurisdiction and disposition hearing on December 14,
2022, the parties presented arguments about the sufficiency of
the evidence supporting dependency jurisdiction. The

                               11
Department argued that both parents had failed to appropriately
follow up on the medical instructions regarding Justin’s diabetes.
Mother had missed multiple medical appointments despite efforts
to follow up with her. While she participated in training, she did
not grasp how to deal with Justin’s diabetes and the importance
of regular glucose testing and insulin. In addition, father was not
sufficiently involved, had not received the necessary medical
training, and had left the burden of care on mother. Also, father
had no place to care for the children. The caretakers were the
ones making sure the children were receiving what was needed.
As to Noah, the Department noted that no follow-up had been
done on his anemia, and the child remained at risk. Minor’s
counsel joined the Department’s arguments regarding the
medical neglect of Justin and Noah, emphasizing that mother’s
statements that Justin was cured were concerning.
       Mother’s counsel argued the petition should be dismissed,
or in the alternative that the court should consider a plan under
sections 301 or 360, subdivision (b). Counsel argued that mother
denied neglecting her children’s medical needs, as she obtained
the required training and attended follow up appointments.
Instead, while she was previously processing the medical
diagnoses and trying to stay on top of appointments, she had a
stronger support system now. Mother’s counsel argued against
removal of the children, contending the Department did not meet
the standard of clear and convincing evidence.
       Father’s counsel also urged the court to either dismiss the
counts involving his children or for a contract under sections 301
or 360, subdivision (b). Counsel argued father had not been
involved previously, and so was unaware of the medical issues,

                                12
but he was more involved now, attending appointments and
being there for his children’s needs.
      On rebuttal, the Department was not willing to do a section
301 contract, and objected to an order under section 360,
subdivision (b).
      After considering the Department’s reports and arguments
of counsel, the court noted that some of mother’s statements in
the reports were “just absolutely shocking to the court.” Mother
responded in court, “Yeah. They’re atrocious. Sorry.” The court
found the Department had also met its burden as to father’s
failure to protect, stating that it was disingenuous for father to
claim he would have come as soon as he knew anything, given
that father had not been involved for the past fourteen years.
      In considering father’s request for a home of parent order,
the court asked whether father had received diabetes training at
the hospital. Father’s counsel reported that father was in the
process of enrolling, but argued that since father was now
involved and had unmonitored visits, there was no risk and no
concern. The court responded, “There is plenty of risk. The man
doesn’t know how to treat a diabetic child. You don’t think that’s
risky? He didn’t even know he had a diabetic child until this case
opened.”
      The court sustained the first two counts of the petition,
relating to medical neglect of Justin and Noah, and dismissed the
counts relating to physical abuse of Justin and father’s failure to
provide supervision and care. It ordered the children removed
from parental custody, finding by clear and convincing evidence
that there was no reasonable means to protect the children
without removal, and that reasonable efforts had been made to
avoid removing the children. It ordered mother to attend all

                                13
medical appointments, to attend a specific parenting class to
address Justin’s medical needs, and counseling with a
Department-approved therapist to address case issues. Mother
would have her visits monitored by a Department-approved
monitor, with the Department having discretion to liberalize
visits. Father’s orders were similar, but with unmonitored visits
with his children. The children would have individual
counseling, and conjoint with mother and father when the
therapist deemed appropriate.

                           DISCUSSION

A.    Jurisdiction

       Both mother and father contend there is insufficient
evidence to support jurisdiction under section 300, subdivisions
(b)(1) and (j), because any risk of harm had been fully addressed
by the date of the adjudication hearing. For a child to be found a
dependent of the juvenile court under section 300, subdivision
(b)(1), the court must find the child has suffered, or there is a
substantial risk that the child will suffer, serious physical harm
or illness as a result of the failure or inability of the child’s parent
or guardian to adequately supervise or protect the child. Section
300, subdivision (j), authorizes a juvenile court to assume
dependency jurisdiction over a child when the following two
requirements are met: “[t]he child’s sibling has been abused or
neglected, as defined in subdivision [(b)(1) or other subdivisions],
and there is a substantial risk that the child will be abused or
neglected, as defined in those subdivisions.” Section 300,
subdivision (j) states courts should consider, when deciding

                                  14
whether to assert jurisdiction, the age and gender of each child,
the nature of the abuse or neglect of the sibling, the mental
condition of the parent or guardian, and any other factors the
court considers probative in determining whether there is a
substantial risk to the child. (§ 300, subd. (j).) “ ‘[¶] The broad
language of [section 300,] subdivision (j) clearly indicates that the
trial court is to consider the totality of the circumstances of the
child and his or her sibling in determining whether the child is at
substantial risk of harm, within the meaning of any of the
subdivisions enumerated in subdivision (j). The provision thus
accords the trial court greater latitude to exercise jurisdiction as
to a child whose sibling has been found to have been abused than
the court would have in the absence of that circumstance.’
[Citation.]” (In re I.J. (2013) 56 Cal.4th 766, 774.) “[T]he more
severe the type of sibling abuse, the lower the required
probability of the child’s experiencing such abuse to conclude the
child is at a substantial risk of abuse or neglect under section
300. If the sibling abuse is relatively minor, the court might
reasonably find insubstantial a risk the child will be similarly
abused; but as the abuse becomes more serious, it becomes more
necessary to protect the child from even a relatively low
probability of that abuse.” (Id. at 778.)
       “ ‘In reviewing the jurisdictional findings . . . , we look to
see if substantial evidence, contradicted or uncontradicted,
supports them. [Citation.]’ ” (In re R.T. (2017) 3 Cal.5th 622,
633.) Under this standard, “we view the record in the light most
favorable to the juvenile court’s determinations, drawing all
reasonable inferences from the evidence to support the juvenile
court’s findings and orders.” (Ibid.)

                                 15
       “Substantial evidence must be of ponderable legal
significance. It is not synonymous with ‘any’ evidence.
[Citation.] The evidence must be reasonable in nature, credible,
and of solid value. [Citation.]” (In re Dakota H. (2005) 132
Cal.App.4th 212, 228.) “The appellant has the burden of showing
there is no evidence of a sufficiently substantial nature to support
the finding or order. [Citations.]” (Ibid.) “ ‘. . . “The ultimate test
is whether it is reasonable for a trier of fact to make the ruling in
question in light of the whole record.” [Citation.]’ [Citation.]” (In
re Yolanda L. (2017) 7 Cal.App.5th 987, 992.)

Sufficient evidence to support jurisdiction

       Both parents focus their arguments on whether the
evidence supported a determination that a substantial risk
existed at the time of the jurisdictional hearing, implicitly
conceding that a substantial risk did exist at the time the petition
was filed. They both argue that by the time the adjudication took
place in December 2022, any risk of harm had been eliminated
because father was developing a relationship with Jacob and
Justin, father and mother were communicating in a constructive
manner, and all four children were being taken to their medical
appointments. Mother’s opening brief states: “whatever
concerns existed . . . in August 2022, by the time of the
December 14, 2022 jurisdiction hearing four months later,
circumstances had changed significantly, to the extent that there
was no substantial evidence of a current risk that mother would
fail to provide Justin adequate medical treatment.” Mother also
points to evidence of father’s increased involvement with the
family, arguing that father “had stepped up and begun assuming

                                  16
his parental responsibilities for his sons.” Father similarly
argues that by the time of the jurisdictional hearing, father had
become involved and Justin’s medical needs were being met.
       “A parent’s past conduct is a good predictor of future
behavior.” (In re T.V. (2013) 217 Cal.App.4th 126, 133, italics
omitted.) “To establish a defined risk of harm at the time of the
hearing, there ‘must be some reason beyond mere speculation to
believe the alleged conduct will recur. [Citation.]’ [Citation.]”
(In re D.L. (2018) 22 Cal.App.5th 1142, 1146.)
       “A dependency court is not required to ‘wait until a child is
seriously abused or injured to assume jurisdiction and take steps
necessary to protect the child.’ [Citation.] Where jurisdictional
allegations are based solely on risk to the child, and not on past
injury, a juvenile court ordinarily determines whether a
substantial risk of harm exists at the time of the jurisdiction
hearing. [Citations.]” (In re J.M. (2019) 40 Cal.App.5th 913, 921
[reversing juvenile court’s determination that dependency
jurisdiction was not warranted, where parents failed to attend to
child’s medical needs and absconded with child to avoid removal
warrant].)
       In evaluating current risk, the juvenile court “should
consider the nature of the conduct and all surrounding
circumstances. It should also consider the present circumstances,
which might include, among other things, evidence of the parent’s
current understanding of and attitude toward the past conduct
that endangered a child, or participation in educational
programs . . . .” (In re J.N. (2010) 181 Cal.App.4th 1010, 1025–
1026.)
       The parents’ failure to provide Justin with the medical and
emotional support and supervision necessary to handle his

                                17
diabetes diagnosis posed a risk of significant harm, supporting
the juvenile court’s exercise of jurisdiction over Justin under
section 300, subdivision (b)(1), and over his siblings under section
300, subdivision (j). As the doctor explained, a person with
diabetes must monitor their glucose levels several times a day,
and insulin is comparable to oxygen. Left untreated, diabetes
can not only lead to a whole host of serious physical problems,
but can also have detrimental psychological effects. (See, e.g., In
re M.S. (2009) 174 Cal.App.4th 1241, 1246 [father of 14-year-old
juvenile delinquent believed his son’s behavioral problems were
related to depression caused in part his diabetes diagnosis at age
11].)
       The record before us establishes mother’s repeated pattern
of blaming others or denying responsibility in situations where
her children needed additional support or intervention, and
refusing any support that was offered. Mother repeatedly
ignored or rebuffed efforts by nurses, school counselors, and the
social workers to engage with her and provide assistance. Rather
than enrolling the older children in counseling to help with
behavioral and anger problems, mother refused services and
blamed the school for racially targeting her son. Rather than
responding to the school’s request for supplies to help monitor his
glucose levels or helping Justin to accurately monitor his levels,
mother repeatedly and incorrectly insisted Justin no longer had
diabetes or needed insulin because he had lost 60 pounds.
Mother’s ongoing refusal or inability to acknowledge her child’s
medical needs poses a substantial risk of significant harm. (See
In re Esmeralda B. (1992) 11 Cal.App.4th 1036, 1044 [“denial is a
factor often relevant to determining whether persons are likely to
modify their behavior in the future”]; see also In re Gabriel K.

                                18
(2012) 203 Cal.App.4th 188, 197 [“[o]ne cannot correct a problem
one fails to acknowledge”].)
        In the Department’s October 27, 2022 last minute
information, which parents rely upon as part of their insufficient
evidence argument, father stated he was open to a class on
medically fragile children, but was still trying to enroll in a
diabetes class to learn more about the disease and help more.
Despite his lack of diabetes education, he stated did not believe
his children had any unmet needs. While our record lacks any
details about what type of training father ultimately underwent,
nurse Tobo reported on December 7, 2022, that father was
scheduled for follow-up training, which supports an inference
that father still needed additional training before he could help
Justin manage his diabetes. The evidence of improvement that
mother and father rely upon does not establish that there was no
significant risk of harm to Justin without the court’s
involvement. To the contrary, in light of father’s past lack of
involvement, it would be reasonable to infer that absent
dependency jurisdiction and the children’s detention from
mother’s custody, father would have continued to leave primary
responsibility for the children’s needs with mother.
        When viewed in the light most favorable to the judgment, it
is not speculative to conclude that even with an improved
relationship between father and Jacob and Justin, and more
consistent attendance at medical appointments, that there was
still a substantial risk that Justin’s medical needs would be
neglected in the future, absent court intervention.
        Given our conclusion that there is substantial evidence to
support the petition’s first count, under subdivisions (b)(1) and (j)
of section 300, concerning risk to the children based on the

                                 19
parents’ medical neglect of Justin, we need not consider whether
jurisdiction was warranted based on the count concerning Noah’s
anemia. (In re Alexis E. (2009) 171 Cal.App.4th 438, 451 [when a
petition alleges multiple counts and a reviewing court affirms
based on one, the court need not consider the remaining counts].)

B.    Removal order

       Section 361, subdivision (c)(1) provides for the removal of a
dependent child from the physical custody of the parent “with
whom the child resides at the time the petition was initiated” if
the court finds by clear and convincing evidence that “[t]here is or
would be a substantial danger to the physical health, safety,
protection, or physical or emotional well-being of the minor if the
minor were returned home, and there are no reasonable means
by which the minor’s physical health can be protected without
removing the minor from the minor’s parent’s . . . physical
custody.” Subdivision (d) contains similar provisions with respect
to removal from a parent with whom the child did not reside.
(§ 361, subd. (d) [removal requires finding of substantial danger,
as in subd. (c)(1), for the parent to live with the child rather than
for the child to return home].) “[B]oth subdivision (c) and
subdivision (d) impose the same factfinding requirements and
heightened clear and convincing burden of proof for removal.” (In
re S.F. (2023) 91 Cal.App.5th 696, 720 [any error in removal
order under section 361, subd. (c), rather than subd. (d) was
harmless].)
       “ ‘On appeal from a dispositional order removing a child
from a parent we apply the substantial evidence standard of
review, keeping in mind that the trial court was required to make

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its order based on the higher standard of clear and convincing
evidence.’ ([In re] Ashly F. [(2014)] 225 Cal.App.4th [803,] 809;
see Conservatorship of O.B. (2020) 9 Cal.5th 989, 1005 [‘when
presented with a challenge to the sufficiency of the evidence
associated with a finding requiring clear and convincing evidence,
the court must determine whether the record, viewed as a whole,
contains substantial evidence from which a reasonable trier of
fact could have made the finding of high probability demanded by
this standard of proof’].) ‘ “ ‘ The ultimate test is whether it is
reasonable for a trier of fact to make the ruling in question in
light of the whole record.’ [Citation.]” [Citation.]’ [Citation.]”
(In re I.R. (2021) 61 Cal.App.5th 510, 520–521.)
       Even taking into account the clear and convincing standard
of proof, considering the record as a whole, the evidence discussed
above is sufficient to support the court’s removal order.

C.    ICWA

Relevant ICWA facts

       At the detention hearing, father denied any Indian
ancestry, but maternal grandmother claimed her great-great
grandmother may have Cherokee ancestry. The court directed
maternal grandmother to provide the social worker with contact
information for relatives that might have information, but found
no reason to know ICWA applied. Paternal grandfather denied
Jacob and Justin had any Indian ancestry on the paternal side of
their family. The Department was in contact with other
relatives, including Noah and Ryan’s father and paternal great
aunt, but there is no evidence those individuals were asked

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whether they had reason to believe any of the children had
Indian ancestry.

Analysis

      Mother contends the Department’s initial inquiry into the
children’s possible Indian ancestry was inadequate under section
224.2. The Department contends the issue is moot because the
juvenile court made a December 13, 2023 order consistent with
the relief mother seeks on appeal. In her reply brief, mother
contends the December 13, 2023 order is inadequate because it
orders the Department to generally investigate family members
about ICWA, but does not identify specific relatives.
      An appeal is moot when it is impossible for the appellate
court to grant the appealing party any effective relief. (In re D.P.
(2023) 14 Cal.5th 266, 276.) Stated differently, “the critical factor
in considering whether a dependency appeal is moot is whether
the appellate court can provide any effective relief if it finds
reversible error.” (In re N.S. (2016) 245 Cal.App.4th 53, 60.)
      We grant the Department’s motion for judicial notice.
(Evid. Code, § 452, subd. (d).) The lack of specificity in the court’s
December 13, 2023 order directing the Department to further
investigate family members regarding ICWA does not preclude
the court from ensuring that the Department makes a
meaningful effort to interview available relatives. Because
juvenile court has already ordered the Department to take
additional steps to investigate the possibility ICWA may apply,
there is no effective relief we can provide on appeal, and mother’s
appeal of the court’s ICWA determination is moot. (In re Baby
Girl M. (2022) 83 Cal.App.5th 635, 638–639.) Further, in these
circumstances, we decline to exercise our discretion to consider

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the moot issue, as the continued proceedings in the juvenile court
ensure that any allegedly erroneous ICWA determination in this
case is not insulated from future review, and the ICWA
determination is not in any way stigmatizing or prejudicial to
appellants. (See In re D.P. supra, 14 Cal.5th at 285-287.)

                         DISPOSITION

      The December 14, 2022 jurisdiction and disposition orders
are affirmed.
      NOT TO BE PUBLISHED.

                              MOOR, J.
      We concur:

      BAKER, Acting P. J.

      LEE, J.

     Judge of the San Bernardino Superior Court, assigned by
the Chief Justice pursuant to article VI, section 6 of the
California Constitution.

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