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This could be a case where Congress might assert itself.

The problem is that if Trump never nominates anybody, they need to have somebody in charge.

I guess one option would be if Trump appoints an "acting," and does not nominate any permanent secretary within the 120 days, the acting should be thrown out, and people from the current chain of command would automatically move into the acting position, according to a defined succession sequence. At least that way, Trump would not have any say over who it is.

Another option would be that if Trump fails to nominate a permanent Secy during the 120 days, then the next in succession would automatically be nominated, and if they accept the nomination, they would stand before the Senate for confirmation as usual. And if the Senate found that person unqualified, they could keep going down the succession line until they found one who they think is qualified. Trump would hate that, and that would force Trump to make a real nomination.