Opinion
No. 1-13-3258
12-22-2014
IN THE INTEREST OF: FATIMA A., a minor, Plaintiff-Appellant, v. ILLINOIS DEPARTMENT OF CHILDREN AND FAMILY SERVICES, an administrative Agency in the State of Illinois; BOBBIE GREGG, Acting Director of the Illinois Department of Children and Family Services; and ARTHUR SUTTON, Administrative Law Judge in the Administrative Hearings Unit of the Illinois Department of Children and Family Services, Defendants-Appellees.
NOTICE: This order was filed under Supreme Court Rule 23 and may not be cited as precedent by any party except in the limited circumstances allowed under Rule 23(e)(1). Appeal from the Circuit Court of Cook County. No. 11 CH 31027 Honorable Franklin Valderrama, Judge Presiding. JUSTICE CONNORS delivered the judgment of the court.
Presiding Justice Delort and Justice Harris concurred in the judgment.
ORDER
Held: The final administrative decision was not against the manifest weight of the evidence, was not legally erroneous, was not clearly erroneous, and did not constitute a denial of due process or a violation of the Illinois Administrative Procedure Act. ¶ 1 The plaintiff, Fatima A., appeals from the circuit court's order affirming a decision of defendant Erwin McEwen (Director), the Director of defendant Illinois Department of Children and Family Services (DCFS) upholding the denial of specialized foster care services for plaintiff. Plaintiff alleges that: (1) the final administrative decision was against the manifest weight of the evidence because the decision found that all of plaintiff's needs were being met despite the fact that plaintiff had severe eczema and had not yet seen a dermatologist, (2) the final administrative decision was legally erroneous where it concluded that plaintiff was not eligible for specialized care because her needs were being met, (3) the final administrative decision was clearly erroneous where it concluded that DCFS had met its burden of showing that the decision to deny specialized care was consistent with her well-being despite plaintiff's severe medical and behavioral problems, and (4) the final administrative decision constituted a denial of due process and a violation of the Illinois Administrative Procedure Act (5 ILCS 100/1-1 et seq. (West 2012)), where it was arbitrary and capricious. For the following reasons, we affirm.
Pursuant to section 2-1008(d) of the Illinois Code of Civil Procedure (735 ILCS 5/2-1008(d) (West 2012)) we have amended the caption to correctly reflect the current department acting director. On our own motion, we hereby substitute her as a party as shown above.
¶ 2 I. BACKGROUND
¶ 3 On October 18, 2010, DCFS's Child and Youth Investment Team (CAYIT) denied the request of Melanie B., plaintiff's guardian, for specialized foster care services for plaintiff. Melanie B. appealed that finding. ¶ 4 On May 20, 2011, a hearing was held before an administrative law judge (ALJ) at the DCFS Administrative Hearings Unit. The ALJ first noted that plaintiff had the burden of proof in this case, not DCFS. Plaintiff's counsel preserved for appeal the issue of burden of proof, stating that it was plaintiff's belief that DCFS had the burden of proof by a preponderance of the evidence to show that the action it took was in the best interest of the child. ¶ 5 Melanie B. testified first, stating that plaintiff was placed in her home when she was 11 days old, and was now three years old. When she was first placed in the home, plaintiff had severe acid reflux and muscle rigidity on one side of her body due to drug exposure in utero. Plaintiff began physical therapy in May 2008 and was discharged a little over a year later. It was recommended that she continue exercises like swimming, which plaintiff could not do due to tubes in her ears. Melanie B. testified that plaintiff was in gym classes and ballet classes at the time of the hearing. The gym classes were at a private facility because the facility disinfected the room before and after classes, whereas the park district facilities did not. Due to plaintiff's allergies, this was necessary. Melanie B. testified that plaintiff had both food and other allergies. Her food allergies were dairy (especially milk), soy, citrus, and eggs. The dairy allergy was both by ingestion and by touch. If plaintiff touched milk, she "immediately welts up, starts itching" and her eczema flared up. Ingesting it "closes her throat" and makes her vomit. Soy caused upset stomachs, and citrus caused open sores in her mouth. Eggs caused plaintiff's eczema to flare up. ¶ 6 Melanie B. testified that plaintiff also has asthma and eczema. Her skin gets very dry and scaly from her neck down. She has a prescription cream that Melanie B. puts on her every night. She also has two topical creams. She keeps a prescription medication for eczema at plaintiff's school as well. ¶ 7 Melanie B. testified that plaintiff's other allergies included dog dander, bug spray, and wool. Plaintiff's skin raised up wherever her eczema was when she touched dog dander, which would cause her to scratch the skin and bleed. Bug spray caused welts and throat closing. Wool caused "contact dermatitis." ¶ 8 Melanie B. further testified that plaintiff was on prescription medicine for each different allergy. Melanie B. stated that she has hypoallergenic air purifiers in every room, and a hypoallergenic vacuum at home. She also has special sheets, bedding, pillowcases, detergents, soaps, lotions, and wipes for plaintiff. Melanie B. testified that she also has medication for her food allergies, besides an epinephrine pen (epi pen). Plaintiff is also on prescription eye drops for eye infections. ¶ 9 Melanie B. further testified that plaintiff was in behavioral therapy at Illinois Masonic with Jennifer Bailey, which started January 5, 2011. Plaintiff was also in art therapy at school, which was recommended by her social worker at school after she refused to answer test questions during routine testing. At the time of the hearing, she did art therapy once a week. Melanie B. testified that plaintiff's school social worker also recommended individual therapy and gave her a phone number at Illinois Masonic. Melanie B. testified that plaintiff's pediatrician also agreed that therapy would benefit plaintiff because her tantruming was becoming out of control. Melanie B. initiated the therapy because plaintiff's home behavior was becoming erratic. She was tantruming, crying for long hours at a time, shutting down in social situations, and becoming paranoid in public settings. ¶ 10 Melanie B. testified that plaintiff was also becoming abusive towards her and her biological daughter. She testified that plaintiff would "hit us, pinch, bite, kick." Melanie B. testified that plaintiff saw Bailey at Illinois Masonic once a week. Bailey also did family therapy with Melanie B. and occasionally with her biological daughter. Melanie B. testified that she went to an eight-week-long parenting class for children with disruptive behaviors and talked to Bailey about what she learned. ¶ 11 On cross-examination, Melanie B. testified that plaintiff generally did not have acid reflux anymore, and that the physical therapy for plaintiff's muscle rigidity was terminated because it was successful. She testified that plaintiff had never been to an allergist but that her doctor was going to refer her to one. ¶ 12 Melanie B. further testified on cross-examination that plaintiff no longer has ear infections, and that she passed her hearing tests after the tubes were put in her ears. Plaintiff is also no longer in need of a speech therapist. Melanie B. testified that the tantruming did not happen as often at school as it did at home. ¶ 13 Melanie B. further testified that plaintiff's mother's rights were terminated in January 2011, and the goal was now adoption, regardless of whether plaintiff was considered specialized or not. She testified that all the services she had described including therapy, were covered by "the medical card" which Melanie B. did not have to pay for. She testified that the prescriptions were also paid for by the medical card. Melanie B. testified that plaintiff's gym classes were covered by DCFS's monthly board check. She received $392 or $397 monthly for plaintiff, plus $100 every month for gym classes. ¶ 14 Melanie B. testified that if plaintiff was considered specialized and she received extra money, she would use the money for other classes, and equipment she needs in the house that is not covered by the medical card. She also has to purchase bedding every three months for plaintiff, as DCFS purchased the original bedding, but not the replacement bedding. DCFS also purchased the original air purifiers, but Melanie B. testified it would not purchase the replacements. Melanie B. also testified that she wanted a respite worker from DCFS because she could not leave plaintiff with "just anyone." ¶ 15 Finally, Melanie B. testified that it was her belief that after adoption, plaintiff's behavioral therapy would be covered through the medical card. ¶ 16 It was then stipulated that if called to testify, Jennifer Bailey would state that she is a behavioral clinician at Advocate Illinois Masonic Medical Center. In her initial assessment of plaintiff, she determined that plaintiff needed weekly individual therapy as well as family therapy with Melanie B. She recommended that Melanie B. engage in a parenting group for parents of children with disruptive behavioral problems. Bailey would state that she is addressing issues with plaintiff that include "violence towards others, tantruming, shutting down in social situations, suspicious or paranoid behavior such as thinking that everyone is watching or laughing at the minor, and obsessive compulsive disorder behaviors." Bailey would further testify that plaintiff "is making very little progress in identifying triggering behaviors." ¶ 17 DCFS then put on its case, calling Dr. Lia Knox, a CAYIT reviewer, as its first witness. Dr. Knox testified that she had a PhD in psychology. She was present at the CAYIT staffing that occurred on October 18, 2010, in regards to plaintiff. The purpose of the CAYIT was to talk about placement and specialized care for plaintiff. Dr. Knox testified that in order to receive specialized care, a minor has to have certain medical issues, psychological issues, or behavioral issues that warrant more services from DCFS. ¶ 18 Dr. Knox further testified that whether a minor should receive specialized care is covered by DCFS Rule 301.90(b) (89 Ill. Admin. Code 301.90(b)) (West 2010)), which states that the first thing that would need to occur would be a CAYIT staffing, which did occur in this case. Dr. Knox testified that examples of minors that require specialized care included minors with an IQ of 70 or below "which is in the mental retardation realm," certain medical issues that deem more hospitalization or more medical care, autistic children who tend to have moderate or behavioral, perception, and sensory issues, children in need of behavioral care or if they have highly sexualized behavior and cannot be around other children, and adolescents whose behavior has caused them to be placed in several different homes. ¶ 19 Dr. Knox acknowledged that the portion of the rule at issue here was whether plaintiff had a medical or physical condition or impairment that required an extraordinary level of daily supervision or assistance. Dr. Knox testified that an example of a minor that would fall under that category would be one that had breathing tubes or walking instruments to aid in walking, or if a child had a brain injury which caused seizures. She further testified that children with Down's syndrome, or paralysis or neurological problems would fall into this category ¶ 20 Dr. Knox further testified that from what she remembered, plaintiff was very active at home, was playful, "a joy to be with," inquisitive, and curious. Dr. Knox testified that plaintiff did well in school and was a leader. She was able to get along with other kids "very well." ¶ 21 She further testified that plaintiff would not qualify for specialized foster care when looking at the four factors listed in the Code: (1) the child's individual function in the home, school, and community, (2) the child's current or recommended involvement in identified services; (3) the child's degree of need, and (4) the caregiver's required level of participation in activities and/or services needed to meet the child's treatment and educational needs. Dr. Knox testified that plaintiff would not qualify under the first provision because she was doing well and her medical needs were being taken care of. She had special lotion for her skin and had the appropriate medical checks on time. Dr. Knox testified that she would not meet the second factor either because she was functioning well both at school and at home. In regards to the third factor, Dr. Knox testified that plaintiff had received the medical care she needed and that plaintiff was stable when she saw her. Finally, Dr. Knox testified that plaintiff did not qualify under the fourth factor either because Melanie B. was meeting all of plaintiff's needs. ¶ 22 Dr. Knox testified that the primary goal in regards to specialized foster care is to make sure that both the child and the family have the appropriate services in place to maintain a child in that home so there are no disruptions and the child receives the best care possible. ¶ 23 On cross-examination Dr. Knox stated that she was unaware that plaintiff was in family therapy, that plaintiff had been diagnosed with disruptive behavior disorder, that she was being treated for obsessive-compulsive behaviors, that she was being treated for paranoid behaviors, or that she required eight or more prescriptions a day. Dr. Knox testified that knowing those things would not change her opinion that plaintiff's needs were being met, however, since plaintiff was receiving those prescriptions and attending therapy and did not seem to need additional services. ¶ 24 DCFS then rested, and the ALJ asked Melanie B. a few additional questions. In response, Melanie B. stated that the prescriptions and the doctors were the only services covered by the medical card, and that she wanted additional money. She was not receiving financial assistance with art therapy, food, drinks, soaps, shampoos, detergents, bedding, or air purifiers. Melanie B. testified that she was told that once plaintiff was adopted, DCFS no longer had any responsibility for anything not provided by the medical card. ¶ 25 On June 14, 2011, the ALJ issued a recommendation and opinion, finding that plaintiff did not meet her burden of proof, thereby denying plaintiff's appeal from CAYIT's denial of specialized care. On September 1, 2011, plaintiff filed a complaint for administrative review in the circuit court. On April 26, 2012, the circuit court entered an agreed order remanding the matter back to DCFS for reconsideration of the denial of specialization, and for a supplemental hearing with instructions to allow new evidence as necessary, current up through the supplemental hearing date, with the burden of proof on DCFS instead of plaintiff. ¶ 26 A subsequent hearing was held on July 18, 2012. The ALJ noted that this hearing would leave off from the prior hearing, instead of resubmitting all the evidence and testimony that was given at that time. Tanya Parker, a DCFS worker assigned to plaintiff's case, testified first. Parker testified that she was assigned to plaintiff's case in May 2011, and that plaintiff is now four years old. She testified that plaintiff has visible eczema all over her body, and has certain food and environmental allergies. Parker testified that plaintiff has high anxiety. ¶ 27 Parker further testified that plaintiff is allergic to dairy, grass, dander, mold, pollen, and cats. She is currently on medication for her allergies and has gone to see a specialist at North Shore University Health System. Dr. Rachel Story prescribed creams for plaintiff's eczema. Parker testified that plaintiff has asthma, but has prescribed medication for that, as well as a nebulizer. Parker testified that the doctor has stated that her allergies are currently under control. ¶ 28 Parker testified that plaintiff went to the doctor in February 2012 for an asthma attack, and was hospitalized in March 2012 for pneumonia. ¶ 29 Parker further testified that plaintiff was in individual therapy for behavioral management. Brittany Neef, the therapist from Advocate Illinois Masonic Medical Center, was plaintiff's therapist. Parker testified that Neef indicated in a June 13, 2012, report that plaintiff was referred to the Pediatric Developmental Center for a comprehensive evaluation. It was then recommended after the comprehensive evaluation that plaintiff needed group therapy. Plaintiff is currently on a waiting list for the group therapy. Parker testified that the parent must go to therapy first before the child can attend either group therapy or parent/child therapy, and that Melanie B. was currently in therapy. Parker testified that individual therapy ended in May 2012 when Neef left the practice. Parker testified that plaintiff was still in art therapy at school. ¶ 30 Parker further testified that plaintiff does not exhibit the same behaviors at school as she does in the foster home, and that the school has not reported any concerns regarding plaintiff's behavior. Parker testified that plaintiff underwent a developmental and behavioral diagnostic summary on February 22, 2012, after which Dr. Cupoli stated plaintiff exhibited anxiety issues. ¶ 31 Parker additionally testified that plaintiff was referred to System of Care (SOC) in June 2012, due to "this appeal" and "things that were going on." Parker testified that members of SOC had met with plaintiff at least four times, and that at the conclusion of the initial assessment, it was concluded that plaintiff probably did not qualify for SOC services because she was receiving community-based services. ¶ 32 Parker testified that Melanie B. "absolutely" wanted to adopt plaintiff, and that plaintiff functions in the home as if Melanie B. is her mother. Parker testified that plaintiff is very attached to Melanie B., and very attached to Melanie B.'s biological daughter. Parker testified that Melanie B.'s mother lives upstairs from them, and that plaintiff is attached to her grandparents as well. During Parker's visits, plaintiff "[e]ngages in play," has a nice bedroom, and Melanie B. has made sure plaintiff's needs are met. Parker further testified that plaintiff is very aware of her allergies and problems and she has been "taught and trained" about them. ¶ 33 Parker testified that at school plaintiff seems overall pleasant, but more of a loner. Other children have to engage plaintiff in order for her to play with them. Plaintiff has had some incidents where she has gotten into fights with her peers or does not want to share, but that is not a daily occurrence. ¶ 34 On cross-examination, Parker testified that Melanie B. regularly reported tantruming at home, violence at home, and that plaintiff occasionally had paranoia. Parker further testified that Melanie B. had recently reported to her that plaintiff had compulsive behaviors, that she was shutting down, and that she was exhibiting avoidance behaviors. Parker further stated that she was aware that Melanie B.'s biological daughter was seeking therapy because of plaintiff's behavior in the home. Parker testified that all of plaintiff's needs were being met and would continue to be met once adoption was finalized. ¶ 35 Melanie B. then testified on behalf of plaintiff. She testified that plaintiff is still allergic to soy, egg, citrus, all dairy, dog dander, wool, and bug spray. She testified that plaintiff was seeing an allergist, Dr. Story, who was referred by plaintiff's pediatrician. Melanie B. testified that she called Children's Memorial looking for a dermatologist for plaintiff, but was told to call back on August 13, 2012, as they were booked through October. ¶ 36 Melanie B. testified that a second series of allergy tests revealed that plaintiff was allergic to cats, tall grass, birch trees, penicillin, dust mites, and cockroaches. Melanie B. testified that the treatment for plaintiff's allergies is the same, except that two of the medications have increased in strength. The prescriptions and creams are covered by the medical card, but the lotions are not. Melanie B. testified that she has to purchase "extra that are not covered by the medical card because I'm only allowed one each time." Melanie B. stated that she uses the medical card to purchase one prescription and then she pays out of pocket for duplicates, or she buys a generic brand. ¶ 37 Melanie B. testified that in June 2013, plaintiff went to the emergency room due to swelling on her throat after a lotion was applied. The emergency room doctor recommended a mold machine for plaintiff, so Melanie B. purchased one for plaintiff's bedroom as well as one for the living room, and DCFS did not reimburse her for either. The doctor also recommended an air-conditioner in the summer and a dehumidifier in the winter for her allergies and asthma. ¶ 38 Melanie B. testified that plaintiff's behavior is still the same as it was when she testified at the prior hearing, but that plaintiff's violent behavior and tantruming has increased. ¶ 39 Melanie B. further testified that Neef, at Illinois Masonic, recommended to Melanie B. that plaintiff attend Erikson Institute because Neef "wasn't getting anywhere with her in therapy," and plaintiff was having tantrums in therapy. Erikson Institute no longer had a contract with DCFS, however, so Neef referred her to the Pediatric Development Center. Melanie B. testified that she was taking parenting classes as a prerequisite to plaintiff's ability to participate in group therapy, but that she was on a waiting list for a long time before getting into class because plaintiff "has a medical card." Melanie B. testified that today, plaintiff is not in any services at the Pediatric Development Center. The therapy sessions would be weekly when they start. Melanie B. further testified that she attempted to register plaintiff in daycare at the Center once but was told it could not accommodate plaintiff's allergy needs since other children brought in outside food that could not be controlled. ¶ 40 When asked what services, other than seeking a dermatologist, that Melanie B. needed assistance with, she stated that she was "still waiting on vouchers for * * * the sheets, the bedding, pillow cases, the air machines." Melanie B. stated that she is trying to meet all of plaintiff's needs at this time as best she can with the doctors and additional services, but that she is constantly changing. She testified that right now, with the "services that are going to be put in place" she is meeting plaintiff's needs. ¶ 41 Melanie B. further testified that plaintiff has never been hospitalized, and that she has only ever been to the emergency room. She testified that she has not talked to a doctor about getting a bigger dose of medication at a time, but that she talked to the pharmacist who informed her that her "medical card only covers a certain amount." ¶ 42 Finally, Melanie B. testified that once she adopts plaintiff, she will not get the extra money for gym class, bedding, air machines, and receipts "to purchase extra stuff." Melanie B. testified that she is only looking for more money, not specialized services. ¶ 43 On September 17, 2012, DCFS issued an opinion in which it noted that the issue on remand was whether a preponderance of the evidence supported DCFS's decision to deny plaintiff's request for specialized foster care. It made the following relevant findings of fact. Plaintiff was diagnosed with asthma, atopic eczema, acid reflux, problems with her ears, and mental health and anxiety issues which require constant attention. Plaintiff no longer has tubes in her ears, no longer has acid reflux or ear infections, and is on track for speech and language. Plaintiff is no longer in need of services for speech or language. She is still allergic to dairy products, is currently on "medication for allergy;" and needs a nebulizer for asthma. Plaintiff was hospitalized in February 2012 for an asthma flare up. She needs group and individual child therapy. The decision stated that there were off-and-on behavioral problems at school, and that plaintiff had been involved in fights with boys. However, school reports showed that plaintiff was doing well and did not state any concerns. ¶ 44 The ALJ further found that plaintiff was receiving a special fee every six months, and that she still had hypoallergenic issues. It further found that "[a]ll needs are being met by foster parent through community based services." It found no risk of harm to plaintiff, and that her current placement was safe. Since May of 2011, there had been no unusual incidents reported. The court further found that plaintiff received $100 towards gym classes. DCFS further stated in its decision: "Dermatologist is booked until October, 2012; all creams covered by medical card accept one [sic]. Department did not pay for mold machine because no receipt was presented; no receipt was presented for dehumidifier; sheets, bedding and pillows are covered by DCFS." ¶ 45 The ALJ stated that plaintiff was involved in gymnastics, which costs $430 for 20 sessions and $280 for short sessions. Lastly, the ALJ found that DCFS's witnesses testified credibly. ¶ 46 In addition to those findings of fact, the ALJ made conclusions of law. It found in pertinent part that DCFS had proven by a preponderance of the evidence that the decision made by DCFS to deny specialization was consistent with plaintiff's needs regarding safety, well-being, and permanency pursuant to Rule 337 of Administrative Rules (89 Ill. Admin. Code 337). ¶ 47 In its analysis, the ALJ took judicial notice of the testimony and exhibits offered into evidence during the original hearing on May 20, 2011. The ALJ noted that DCFS argued that all of plaintiff's needs were being met through current services "already being provided." The ALJ noted that Melanie B. located resources to help plaintiff with her medical and behavioral needs and is committed to her well-being. It noted that plaintiff was on a waiting list to receive occupational therapy at Illinois Masonic, and that plaintiff is in art therapy and will be continuing these services. Melanie B. will be contacting Children's Memorial to inquire about a dermatologist appointment. Plaintiff's mental health needs "are also being addressed through a variety of service providers." ¶ 48 The ALJ found that "the Appellants could not show where the minor is in need of any services that were not already being addressed or that could only be provided through specialization." Moreover, the ALJ found, "there has been no showing that [DCFS] is not addressing the necessary services needed for [plaintiff]." The ALJ continued, "[h]ere, [plaintiff's] needs are being met through foster care services already available and in place." The ALJ found that DCFS sustained its burden and the decision to deny the request for specialization was reasonable and consistent with plaintiff's needs with regard to safety, well-being, and permanency. ¶ 49 Plaintiff then appealed to the circuit court for administrative review pursuant to section 3-101 of the Illinois Code of Civil Procedure. 735 ILCS 5/3-101 (West 2012). The court issued a memorandum and order on October 8, 2013, in which it found, with regards to the question of law regarding whether DCFS properly applied the factors listed in section 301.90(b), that DCFS properly applied Section 301.90(b) where it required a recommendation of the CAYIT, and where evidence showed that the CAYIT reviewed the four factors in section 301.90(b) before determining specialized foster care was not needed. ¶ 50 For the mixed question of law and fact, of whether plaintiff qualified for specialization, the court found that DCFS properly analyzed section 301.90(b), which outlines the assessment for specialization of a foster child. The court found that in taking the section into consideration, the ALJ properly considered each factor and found that plaintiff did not qualify for specialization based on testimony and exhibits provided at the hearing. The court found that therefore the ALJ's decision was not clearly erroneous. ¶ 51 In terms of plaintiff's question of fact, regarding whether the ALJ's decision was against the manifest weight of the evidence, the court found that the evidence supported the ALJ's decision to deny plaintiff's request for specialization. The court found that the ALJ had considered testimony from Dr. Knox, Melanie B., and Tanya Parker regarding plaintiff's medical and behavioral issues and needs. The ALJ found those witnesses to be credible and agreed with the conclusion of Dr. Knox that plaintiff did not qualify for specialization. Accordingly, the court found that the record supported the findings of the ALJ and that the decision was therefore not against the manifest weight of the evidence. ¶ 52 Lastly, plaintiff argued that the ALJ violated her due process rights and the Illinois Administrative Procedure Act by imposing requirements for eligibility beyond those in DCFS rules. The court found that plaintiff did not provide the court with any evidence to support her proposition that DCFS's decision was arbitrary or unreasonable. The court affirmed the ALJ's decision and dismissed plaintiff's complaint for administrative review. Plaintiff now appeals.
¶ 53 II. ANALYSIS
¶ 54 Plaintiff contends on appeal that the final administrative decision by the ALJ was (1) against the manifest weight of the evidence where it found that all of plaintiff's needs were being met despite her severe eczema and the fact that she had not yet seen a dermatologist; (2) legally erroneous where it ignored the benefits of the specialization program and added an improper requirement; (3) clearly erroneous where if found that DCFS had met its burden of showing that denial of specialization was consistent with plaintiff's well-being despite plaintiff's physical and behavioral issues that required constant attention; and (4) arbitrary and capricious in failing to consider important aspects of plaintiff's conditions and improperly adding a requirement for specialized care. For the following reasons, we affirm the final administrative decision. ¶ 55 The Administrative Review Law provides that a final decision of the circuit court reviewing the decision of an administrative agency is "reviewable by appeal as in other civil cases." 735 ILCS 5/3-112 (West 2012). This court reviews the agency's decision, not the circuit court's decision. Marconi v. Chicago Heights Police Pension Board, 225 Ill. 2d 497, 531 (2007).
¶ 56 Standard of Review
¶ 57 At the hearings in this case, DCFS carried the burden of proof in showing, by a preponderance of the evidence, that the decision made by CAYIT to deny specialization was in the best interests of the child "in accordance with professional social work standards and [DCFS] administrative rules." 89 Ill. Adm. Code 337.170(a) (West 2012); 89 Ill. Admin. Code 337.30(d) (West 2010). On administrative review, the standard of review applied depends on the issues presented: a question of fact, a question of law, or a mixed question of fact and law. Cinkus v. Village of Stickney Municipal Officers Electoral Board, 228 Ill. 2d 200, 210 (2008). ¶ 58 Where the question of an agency's decision is one of fact, an administrative agency's findings and conclusions of fact are deemed to be prima facie true and correct. 735 ILCS 5/3-110 (West 2012); O'Boyle v. Personnel Board of Chicago, 119 Ill. App. 3d 648, 653 (1983). In examining an administrative agency's factual findings, a reviewing court does not weigh the evidence or substitute its judgment for that of the agency. Cinkus, 228 Ill. 2d at 210. If the issue before the reviewing court is merely one of conflicting testimony and credibility of witnesses, the administrative board's decision should be sustained. O'Boyle, 119 Ill. App. 3d at 653. A reviewing court is limited to ascertaining whether such findings of fact are against the manifest weight of the evidence. Belvidere v. Illinois State Labor Relations Board, 181 Ill. 2d 191, 204 (1998). An administrative agency's factual findings are against the manifest weight of the evidence if no trier of fact could have agreed with the agency or an opposite conclusion than that reached by the agency is clearly evident. Wade v. City of North Chicago Police Pension Board, 226 Ill. 2d 485, 505 (2007). ¶ 59 When an agency's decision deals with a question of law, the agency's findings are not binding on a reviewing court and the agency's decision is reviewed de novo. Cinkus, 228 Ill. 2d at 210. ¶ 60 And finally, mixed questions of law and fact are questions in which the historical facts are admitted or established, the rule of law is undisputed, and the issue is whether the facts satisfy the statutory standard. Cinkus, 228 Ill. 2d at 210. Where a question of an agency's decision is a mixed question of law and fact, it is subject to the "clearly erroneous" standard of review. Marconi, 225 Ill. 2d at 532. An administrative agency's decision is deemed "clearly erroneous" when the reviewing court is left with the definite and firm conviction that a mistake has been committed. Cinkus, 228 Ill. 2d at 210. ¶ 61 Plaintiff contends that all three standards of review apply in this case.
¶ 62 Decision Contrary to Manifest Weight of Evidence
¶ 63 Plaintiff's first contention on appeal is that the ALJ's decision made certain fact findings that were against the manifest weight of the evidence. We first reiterate that in determining whether the decision of the agency was against the manifest weight of the evidence, it is not our function to reweigh the evidence or to make an independent determination of the facts. Abrahamson v. Illinois Dept. of Professional Regulation, 153 Ill. 2d 76, 88 (1992). The mere fact that an opposite conclusion is reasonable or that a reviewing court might have ruled differently will not justify reversal of the findings of fact. Id. "If the record contains evidence to support the agency's decision, it should be affirmed." Id. Additionally, we note that an administrative agency is only required to provide a record and findings to permit orderly and efficient review, and if the testimony at the hearing is preserved in the record, as it was in this case, "specific fact findings are not required." Kimball Dawson LLC v. City of Chicago Dept. of Zoning, 369 Ill. App. 3d 780, 787 (2006). ¶ 64 Here, plaintiff contends that certain findings of fact were against the manifest weight of the evidence because: (1) all of plaintiff's needs were being not being met where she had yet to see a dermatologist; (2) the ALJ's decision did not acknowledge that she was allergic to soy, egg, citrus, dog dander, wool, bug spray, cats, tall grass, birch trees, penicillin, mold, dust mites, and cockroaches, or her severe reactions to these allergens; (3) the decision did not indicate the extreme severity of her eczema or the fact that she had contact dermatitis; (4) while the ALJ's decision mentioned that she was "on medication for allergy" it did not acknowledge that she was on nine daily medications for her allergies; (5) while the ALJ found that all of her creams were covered by the medical card except one, it did not acknowledge that Melanie B. had to provide duplicates of all of plaintiff's medications to the school; (6) the ALJ's findings of fact stated that the hypoallergenic equipment was not paid for by DCFS because no receipts were presented to DCFS despite the fact that Melanie B. testified she was never asked for a receipt and was told DCFS would not pay for such expenses; (7) the decision stated that there had been no unusual incidents reported since May 2011 despite Melanie B.'s testimony that plaintiff had been hospitalized for severe allergic reactions; (8) the ALJ found that plaintiff's needs were met through community-based services despite the fact that plaintiff was not in therapy; (9) the ALJ omitted the fact that plaintiff was diagnosed with disruptive behavior disorder, as well as a sensory regulatory disorder; and (10) the decision stated that plaintiff was doing well in school when in fact there had been fights with other children. ¶ 65 We first note that in regards to plaintiff's arguments that the ALJ failed in its findings of fact to list all of plaintiff's specific allergens, failed to list plaintiff's specific medications, failed to state the severity of plaintiff's eczema or the fact that she had contact dermatitis, failed to note that Melanie B. had to provide duplicate prescriptions to plaintiff's school, and failed to state that plaintiff had both a sensory regulatory disorder and disruptive behavior disorder, "specific fact findings are not required" where the testimony at the hearing was preserved in the record. Kimball Dawson, 369 Ill. App. 3d at 787. Here, the testimony regarding all of these omissions in the ALJ's findings of fact are contained and preserved in the record, and therefore considered by the ALJ. Accordingly, we cannot find that the findings of fact were against the manifest weight of the evidence merely because not every fact presented at the hearings was included. ¶ 66 Plaintiff next takes issue with the ALJ's finding that DCFS "did not pay for mold machine because no receipt was presented for dehumidifier." Plaintiff contends that this finding is against the manifest weight of the evidence because Melanie B. testified that she had never been asked for a receipt, and was told by caseworkers for DCFS that DCFS would not pay for such expenses. We note, however, that if the issue before a reviewing court is merely one of conflicting testimony and credibility of witnesses, the administrative board's decision should be sustained. O'Boyle, 119 Ill. App. 3d at 653. Here, Parker, the caseworker, specifically testified that no receipts had been presented to her, and she did not tell Melanie B. that such expenses were not covered. Moreover, there was testimony that Melanie B. had submitted vouchers and was still waiting to be reimbursed. ¶ 67 Plaintiff further contends that the finding that there had been no unusual incidents reported since May 2011 was against the manifest weight of the evidence because Melanie B. testified that plaintiff had been hospitalized three times for severe allergic reactions, and had notified the caseworker each time. Tonya Parker testified at trial that she had only been notified of one trip to the hospital in February 2012. The ALJ specifically found in its findings of fact that "[plaintiff] was hospitalized in February, 2012 for asthma flare up." To the extent that the ALJ did not specifically find that plaintiff had reported the other two hospitalizations, that decision should be sustained since it is merely one of conflicting testimony and credibility of witnesses. O'Boyle, 119 Ill. App. 3d at 653. Accordingly, we do not find that the ALJ's finding that there were no unusual incidents reported since May 2011, was against the manifest weight of the evidence. ¶ 68 Plaintiff further contends that the ALJ's finding that plaintiff was doing well in school was against the manifest weight of the evidence because "the school had reported to the caseworker about fights that [plaintiff] had had with other children, and described her behavior as 'out of the norm.' " The entire finding of fact made by the ALJ reads: "There are off and on behavior problems at school; [plaintiff] has been involved in fights with boys in school; school reports minor is doing well, did not state any concerns." We find that this is not against the manifest weight of the evidence where Parker testified that the school had not reported any concerns regarding plaintiff's behavior, and Dr. Knox testified that plaintiff was functioning well in school. See O'Boyle, 119 Ill. App. 3d at 653 (findings of agency should be sustained if merely one of conflicting testimony and credibility of witnesses). The fact that plaintiff gets into occasional fights at school does not refute the testimony that she was doing well in school, which the ALJ's findings of fact reflected. ¶ 69 Plaintiff next contends that the finding that plaintiff's needs were being met through community-based services was against the manifest weight of the evidence because plaintiff was not currently in individual therapy. However, at the second hearing, Parker testified that plaintiff's individual therapy was on hold while Melanie B. completed parenting classes. Moreover, Melanie B. testified that once she completely her parenting classes, plaintiff was eligible for individual, group, and child/parent therapy, and had been placed on a waitlist for those services. Accordingly, we find that the ALJ's finding that plaintiff's needs were being met through community-based services was not against the manifest weight of the evidence, as plaintiff was scheduled to begin individual therapy as soon as Melanie B. completed her parenting class. ¶ 70 Finally, plaintiff contends that the ALJ's finding that plaintiff's needs were being met was against the manifest weight of the evidence where she had not yet seen a dermatologist. However, Melanie B. testified at trial that she called Children's Memorial looking for a dermatologist but was told to call back in August 2012, to make a future appointment since the dermatologist was booked through October 2012. The fact that the dermatologist office could not accommodate plaintiff at the time of the hearing does not mean that plaintiff's needs were not being met. It is apparent from the record that the dermatologist office anticipated openings after October, and could accommodate plaintiff at that time. Accordingly, it was not against the manifest weight of the evidence for the ALJ to find that plaintiff's needs were being met despite the fact that plaintiff had not yet been able to see a dermatologist. Rather, if the record contains evidence to support the agency's decision, it should be affirmed." Abrahamson, 153 Ill. 2d at 88.
¶ 71 ALJ's Finding that DCFS Met Its Burden Clearly Erroneous
¶ 72 We next address plaintiff's contention that the ALJ's finding that DCFS met its burden of proof in showing, by a preponderance of the evidence, that the denial of specialization was in the best interests of plaintiff, was clearly erroneous. ¶ 73 At the hearings in this case, DCFS carried the burden of proof in showing, by a preponderance of the evidence, that the decision made by CAYIT to deny specialization was in the best interests of the child and was consistent with the child's needs regarding safety, well being, and permanency. 89 Ill. Adm. Code 337.170(a) (West 2012); 89 Ill. Admin. Code 337.30(d) (West 2010). ¶ 74 Section 301.90(b) of the Code defines what makes a child eligible for specialized services. It states that DCFS "shall provide specialized foster care services for a child * * * who requires such services due to emotional, behavioral, developmental or medical needs, or any combination thereof, or any other needs which require special intervention services * * *. " 89 Ill. Admin. Code 301.90(b) (West 2012). ¶ 75 Examples of medical conditions that may require specialized foster care services, as provided by the Code, include, but are not limited to: a life-threatening disease; dependence on life-saving equipment like a ventilator, dialysis, or oxygen; a medical/physical condition or impairment that requires an extraordinary level of daily supervision and/or assistance; a quadriplegic; severe physical limitations due to multiple physical conditions; hospitalization for psychiatric reasons; or a sexual perpetrator. 89 Ill. Admin. Code 301.90(b)(2) (West 2012). Examples of behavioral and mental health issues that may warrant consideration for specialized care include, but are not limited to: sexual victimization; sexual aggression; fire setting; juvenile delinquency; compulsive behaviors; mental retardation; substance abuse problems or mental illness. 89 Ill. Admin. Code 301.90(b)(3) (West 2012). ¶ 76 When assessing whether a child with one of the above conditions requires specialized foster care services, DCFS "shall also consider the following 4 factors, cumulatively:" (1) the child's individual functioning in her home, school, and community; (2) the child's current or recommended involvement in identified services; (3) the child's degree of need as defined by the recommended intensity and/or frequency of services; and (4) the caregiver's required level of participation in activities and services needed to meet the child's treatment and educational needs. 89 Ill. Admin. Code 301.90(b)(4) (West 2012). ¶ 77 Plaintiff contends that she "clearly fits" the standard articulated in Section 301.90(b) for specialization because she has a "medical/physical condition that requires extraordinary supervision." Plaintiff contends that Melanie B. must monitor her special diet and purchase special equipment for her home, which must frequently be replaced, and which are not covered by her medical card. Plaintiff further contends that Melanie B must bring plaintiff to several doctors, must administer daily medications, and must make sure plaintiff's school has duplicate medications. Plaintiff contends that the Code indicates that asthma, compulsive behaviors, or mental illness could qualify a child for specialization, and that plaintiff has these issues. Further, plaintiff contends that looking at the four factors listed in the Code, plaintiff should have received specialized treatment. ¶ 78 We first note that the examples of medical, physical, and behavioral conditions listed in the Code are described as conditions that "may" require specialized foster care services. The Code then goes on to state that when assessing whether a child with one of those listed conditions requires special services, DCFS shall also consider four factors, cumulatively. Accordingly, the fact that plaintiff has any of the enumerated medical, physical, or behavioral conditions does not automatically result in a finding of specialization. In this case, all four factors were considered, and thus we cannot say that the decision to deny plaintiff specialization was clearly erroneous. ¶ 79 In terms of plaintiff's individual functioning at home, at school, and in the community, Parker testified that plaintiff's school had not reported any concerns regarding plaintiff's behavior, but that she was difficult to engage and had gotten into fights with her peers in the past. Parker testified that during her home visits, plaintiff engages in play, has a nice bedroom, and that Melanie B. makes sure all of plaintiff's needs are being met. While plaintiff has extensive allergies, Parker testified that she was on medication for all of her allergies, and that they were under control. Melanie B. testified that plaintiff exhibited tantruming and violent behavior at home. ¶ 80 Looking at plaintiff's current and recommended involvement in identified services, as well as the degree of need as defined by the recommended intensity and frequency of services, Parker testified that plaintiff was in art therapy, is on a waitlist for group therapy, and will be back in individual therapy once Melanie B. completes parenting class. Parker further testified that plaintiff saw a specialist for her allergies and has prescription medication and creams to treat them. Melanie B. testified that plaintiff has not yet been to see a dermatologist, but was told to call back in August to book an appointment after October. Melanie B. also testified that she was paying out of pocket for the home equipment replacements, and the duplicate medications for plaintiff's school. She further testified that with the services that were going to be put in place, she was meeting plaintiff's needs. ¶ 81 Finally, in looking at the caregiver's required level of participation in activities and services needed to meet the child's treatment and educational needs, we recognize that Melanie B.'s required involvement is certainly extensive. She has to administer prescription medications daily, apply prescription creams daily, take plaintiff to and from several therapy appointments a week, as well as frequent doctor appointments, adhere to plaintiff's strict diet, provide duplicate medications and creams to plaintiff's school, and keep her home hypoallergenic. Melanie B. testified that while plaintiff's needs are currently being met, she needs more money to purchase duplicate medications, to purchase food that plaintiff is not allergic to, and to purchase replacement equipment for her home. However, as the ALJ noted, Melanie B. had never attempted to be reimbursed for the duplicate medications or the replacement equipment for her home, and she had never asked a doctor for duplicate medications. Moreover, considering these four factors cumulatively, we find that the ALJ's decision that DCFS met its burden of proof in showing by a preponderance of the evidence that the denial of specialization was in the best interests of plaintiff, was not clearly erroneous, as we are not left with the definite and firm conviction that a mistake has been committed. Cinkus, 228 Ill. 2d at 210.
¶ 82 Consideration of Current Foster Care Services
¶ 83 Plaintiff also contends that the ALJ improperly considered the current foster care services plaintiff was receiving in determining whether or not her needs were being met. Specifically, plaintiff contends that the Code "nowhere states that simply because a child is getting the services she requires, she is not eligible for the benefits of specialization." The only citation to authority for this proposition, without explanation, is Collinsville v. Regional Board, 218 Ill. 2d 175, 181 (2006). After reviewing Collinsville, we are unsure of how it relates to this case, as it is a case about the failure of a school district to name and serve city residents as defendants. ¶ 84 However, we find that the ALJ considered the proper factors in determining whether plaintiff was eligible for specialization. The Code states that DCFS shall provide specialized foster care services for a child who requires such services due to emotional, behavioral, development, or medical needs, or any combination thereof, or any other needs which require special intervention services. 309 Ill. Admin. Code 301.90(b) (West 2012). The Code further states that a child's eligibility for specialized foster care services shall be determined based upon the recommendation of CAYIT. 309 Ill. Amin. Code 301.90(b)(1) (B) (West 2012). There is no dispute that CAYIT held a staffing on October 18, 2010, and as a result denied plaintiff's request for specialization. The Code then gives examples of medical and behavioral conditions that could warrant specialization, as discussed above, and then lists the four factors that should be used in assessing whether a child with a described condition requires specialized foster care services. 89 Ill. Admin. Code 301.90(b)(4) (West 2012). One of the factors is the "child's current or recommended involvement in identified services," and another factor is the child's degree of need as defined by the intensity and frequency of services. Id. Accordingly, the Illinois Administrative Code specifically indicates that current foster care services should be considered in deciding whether a plaintiff is eligible for specialized services, and thus we cannot find that the ALJ's consideration of these services was legally erroneous.
¶ 85 Arbitrary and Capricious
¶ 86 Plaintiff's final argument on appeal, that the ALJ's decision was arbitrary and capricious in that it imposed requirements for eligibility beyond those in the DCFS rules, must also fail for the same reasons stated above. The ALJ properly considered the necessary factors in concluding plaintiff was ineligible for specialization.
¶ 87 III. CONCLUSION
¶ 88 For the foregoing reasons, we affirm the judgment of the Circuit Court of Cook County upholding the decision of the Director. ¶ 89 Affirmed.