Neglect contributed to the death of a woman at a Gloucestershire prison, an inquest jury has concluded.
Michaela Sweeting, from Bristol, was found unresponsive in her cell at Eastwood Park Prison on 2 June, 2016.
The 38-year-old was arrested and charged with manslaughter in May 2016 and died eight days later, an inquest at Avon Coroner's Court heard.
Coroner Maria Voisin has ordered a Preventing Future Deaths Report as a result of the case.
The jury concluded a series of "gross failures" and "woefully inadequate care" led to the death of the mother-of-five, from Totterdown.
At an earlier hearing the jury heard Miss Sweeting had been prescribed the heroin substitute methadone and despite prison staff noting she seemed over-sedated she was given more.
But the staff did not call for a doctor and they failed to carry out adequate checks on her throughout the night.
The jury's findings stated: "At 22.14 on 1 June she was vomiting and seen by a nurse in her cell.
"Inadequate clinical observations were carried out during the night and on 2 June 2016 at 07:00 Michaela was found unresponsive in her bed with vomit around her mouth."
Speaking after the conclusion of the inquest, her mother Tina Sweeting said: "They failed her.
"It was up to them to make sure she was going to be safe."
Bristol Community Health, which manages healthcare at HMP Eastwood Park, said: "We sincerely apologise for any role we might have played in the events that led to Michaela's tragic death.
"We accept that there were concerns about the handover of clinical information at the time.
"We have significantly improved our handover process since Michaela's death."