Numerous failures contributed to the death of a nurse who was raped and strangled by a convicted sex offender, a jury has ruled.
Lisa Skidmore, 37, was murdered by Leroy Campbell at her home in 2016 - four months after he was released on licence.
Jurors at Black Country Coroner's Court found police and probation staff failures made "more than a minimal contribution" to her "unlawful" death.
They recorded a narrative verdict.
After hearing two weeks of evidence, the panel identified a number of failures that contributed to her death on 24 November 2016.
Campbell, 57, of Forest Road, Moseley, "disclosed to probation he was experiencing low mood, negative thoughts and feelings that had led to his previous offence," but this "key information" was not shared.
Jurors said there were failures to document information and conduct basic checks and there was "no sufficient consideration" given to the option of recalling Campbell to prison.
'Escalation of risk'
On Monday, the inquest heard from sex offender manager Sgt Sophie Clement who said she alerted police about her concerns after a visit to Campbell on 21 October.
The jury's verdict stated: "There was a clear escalation of risk between 17 October and 24 November".
Campbell used step-ladders to climb into Ms Skidmore's home and, after killing her, attacked her 80-year-old mother and set fire to the property in an attempt to destroy evidence.
He was given a whole-life term in 2017, and a review of his case in 2018 by the chief inspector of probation said it was "beyond comprehension" that Campbell was freed.
A probation worker was sacked for gross misconduct over the case.
An HM Inspectorate of Probation review said the public expectation of authorities to "do their job properly" and minimise risks to the public "did not happen in this case".
Last September, former Prisons and Probation Minister Rory Stewart met Ms Skidmore's family twice "to personally apologise" for the failings.
"I will ensure that we change our training, assessments and staff management," he said.
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