The Discipline Committee of the College of Nurses of Ontario has found a Toronto-area Registered Nurse, Ala Malinouskaya, guilty of professional misconduct related to significant documentation failures and the falsification of patient records1. The decision, which was heard via videoconference on April 7, 2025, resulted in a three-month suspension of the nurse’s certificate of registration, along with several remedial requirements and practice restrictions. Ms. Malinouskaya admitted to the allegations, which involved incidents occurring between July and September 2021 while she was employed as a Personal Support Supervisor at S.R.T. MedStaff, a homecare provider. The case centered on her failure to document care for five patients and her improper use of the facility’s electronic tracking system, which resulted in inaccurate records being created for ten separate patient visits.
The Notice of Hearing, dated March 3, 2025, detailed five broad allegations against Ms. Malinouskaya. The first allegation stated that she had committed professional misconduct by contravening a standard of practice of the profession. This was broken down into three parts: first, that she failed to document care provided to five specific patients between September 17 and September 21, 2021, who were listed in “Appendix A” of the notice. Second, that she submitted information to S.R.T. MedStaff verifying that she had attended visits for those same five patients, which she had not actually attended on the dates recorded. Third, that she submitted information verifying visits to five other patients, listed in “Appendix B”, which she had not attended on the specified dates between July 22 and September 21, 2021.
The subsequent allegations stemmed from these actions. The second allegation stated that she failed to keep records as required, specifically referencing the five patients in Appendix A for whom no care was documented. The third allegation was that she falsified a record relating to her practice, which encompassed the inaccurate visit verifications for all ten patients listed in both appendices. The fourth allegation stated that she signed or issued, in her professional capacity, a document that she knew or ought to have known contained a false or misleading statement, again referencing the inaccurate records for the ten patient visits. The fifth and final allegation was that Ms. Malinouskaya engaged in conduct relevant to the practice of nursing that would reasonably be regarded by members of the profession as disgraceful, dishonourable, or unprofessional. This allegation encompassed all the previous failures, including the failure to document care and the submission of inaccurate visit information. Ms. Malinouskaya entered a plea admitting to all allegations. The panel conducted both a written and oral plea inquiry and confirmed that her admissions were voluntary, informed, and unequivocal.
An Agreed Statement of Facts presented to the panel provided context for the misconduct. Ms. Malinouskaya first registered as an RN in Ontario on September 27, 2005, and had no prior discipline history with the College. She was employed as a Personal Support Supervisor at S.R.T. MedStaff from January 2018 until her employment was terminated in September 2021 following an investigation. Her duties included conducting client assessments, training personal support workers, and producing a standardized Supervisor Report after each client visit. The agreed facts specified that Ms. Malinouskaya controlled her own schedule and was not paid per patient visit, establishing that she held no direct financial incentive to document visits that did not occur or were recorded inaccurately.
The core of the issue involved the facility’s electronic records system. The system used software downloaded onto employees’ cell phones to track when home visits were initiated and completed, using GPS data to verify the location. The agreed facts noted that the GPS software could, on occasion, record a client’s address inaccurately. To compensate for this, supervisors, including Ms. Malinouskaya, had the ability to log patient visits even when not physically present at the client’s home. The investigation revealed that Ms. Malinouskaya sometimes logged visits after she had left the clients’ homes. Unbeknownst to her at the time, this action had an unintended consequence: it changed the GPS coordinates associated with the clients’ homes within the facility’s system. The Member did not know her use of the system was causing this error and did not intend for it to happen.
The facility’s IT department discovered the problem after another nurse was unable to validate a visit at a client’s address. An audit revealed that Ms. Malinouskaya’s logging practices had inadvertently changed the GPS coordinates for that client. The IT department then uncovered other instances between July and September 2021 where her actions had changed client addresses in the system. These incidents involved the ten patient visits listed in the Notice of Hearing. For the five visits in Appendix A, Ms. Malinouskaya failed to upload any Supervisor Reports or document any care whatsoever. For the five visits in Appendix B, she did upload Supervisor Reports. However, for all ten visits, her practice of logging them after the fact resulted in the visits being recorded on different dates or at different times than when they actually occurred. Furthermore, she failed to mark any of these as “late entries,” as required by documentation standards.
Ms. Malinouskaya admitted that her actions resulted in false or incorrect records. While she maintained she had no intention of creating false records and that the errors were inadvertent, she accepted that she ought to have known her actions would have this consequence. She acknowledged that her use of the electronic record-keeping system, even if unintentional, resulted in a breach of her professional obligations. The Agreed Statement of Facts outlined several CNO standards she had contravened, including the Code of Conduct (regarding integrity, accountability, and public confidence), the Professional Standards (regarding accountability and taking responsibility for errors), and the Practice Standard: Documentation, Revised 2008. This documentation standard explicitly requires nurses to ensure their records are “accurate, timely and complete,” and to indicate when an entry is made late.
The Discipline Panel accepted the Member’s admissions and the Agreed Statement of Facts, finding that the College had proven the allegations with clear, cogent, and convincing evidence. The panel formally found Ms. Malinouskaya committed professional misconduct as alleged in all five paragraphs of the Notice of Hearing. For the fifth allegation, the panel specified that it found her conduct to be both dishonourable and unprofessional. In its reasons, the panel stated her failure to document care and her false documentation posed a safety risk to clients. It found her conduct reflected a “serious and persistent disregard for her professional obligations” and that she “knew or ought to have known that failing to document care to patients was unacceptable and fell well below the standards of a professional.”
Counsel for the College and for Ms. Malinouskaya proposed a Joint Submission on Order, which the panel reviewed and accepted. The penalty includes several components. First, Ms. Malinouskaya is required to appear before the panel for an oral reprimand within three months of the order becoming final. Second, the panel directed the CNO’s Executive Director to suspend her certificate of registration for a period of three months.
Third, the panel imposed several terms, conditions, and limitations on her certificate of registration. She must attend a minimum of two meetings with a CNO-approved Regulatory Expert at her own expense, to be completed within six months, or up to twelve months if the Expert requires more sessions. Before these meetings, she must review the CNO’s Code of Conduct and Documentation standard, complete the associated Practice Reflection Worksheets, and provide these, along with all case documents, to the Expert. The purpose of these sessions is to review the misconduct, its potential consequences, and prevention strategies, and to develop a learning plan. The Expert must then submit a report to the CNO assessing Ms. Malinouskaya’s insight into her behavior.
Further restrictions will apply upon her return to practice. For twelve months, she must notify any employer of the panel’s decision and provide them with all the case documents. The employer must, in turn, confirm receipt with the CNO and agree to conduct three random spot audits of her documentation practice at four-month, eight-month, and twelve-month intervals, reporting the results of each audit to the CNO. Finally, Ms. Malinouskaya is prohibited from practicing independently in the community for six months after she returns to nursing.
In penalty submissions, College Counsel noted aggravating factors, including the serious and persistent nature of the conduct, which involved ten different clients and brought discredit to the profession. Mitigating factors included her cooperation with the College, her acceptance of responsibility, the lack of financial benefit from her actions, and her clean disciplinary record prior to these events. Counsel for Ms. Malinouskaya reiterated her regret and noted her personal circumstances, stating that the Member had been hospitalized with COVID and was not fully recovered in July 2021 when the conduct began. The panel accepted the joint submission, finding it was not contrary to the public interest. It concluded the penalty was reasonable and satisfied the goals of deterrence, rehabilitation, and public protection.
